输尿管软镜治疗输尿管上段不同CT值结石的临床分析

Clinical analysis of flexible ureteroscopy in the treatment of upper ureteral calculi under different Hounsfield unit(Hu)value

目的探讨输尿管软镜处理输尿管上段不同CT值结石的安全性及有效性。方法回顾性分析2017年6月至2018年6月在温州市中心医院接受输尿管软镜下钬激光碎石术治疗,且结石<20 mm的患者,根据结石CT值>或<800 Hu将患者分为两组,>800 Hu(高CT值组)91例,(低CT值组)88例,比较两组的手术时间、结石清除率及术后并发症发生率。结果低CT值组和高CT值组在年龄、男女比例、结石大小、合并症方面比较差异无统计学意义(P>0.05)。平均手术时长分别为(43±23)min、(50±25)min,差异有统计学意义(P<0.05)。两组间术后并发症发生率分别3.3%、6.8%,差异无统计学意义(P>0.05)。两组清石率分别为94.6%、93.2%,差异无统计学意义(P>0.05)。结论输尿管软镜处理<20 mm输尿管上段结石时安全、有效;结石CT值>800 Hu可使手术时间延长,碎石效率降低。术前评估患者CT值大小可一定程度上评估术后并发症发生率,以便泌尿外科医师选择术式,把握难度。

Objective To evaluate the effect of Hounsfield unit(Hu)value to the efficiency of flexible ureteroscopy(FURS)for the upper ureteral calculi.Methods The data of patients with upper ureteral calculi who were treated by FURS with holmium laser lithotripsy between June 2017 and June 2018,with calculi size<20 mm,at Wenzhou Central Hospital were retrospectively evaluated.Patients were divided into two groups according to the CT value(above 800 Hu or below 800 Hu),the high CT value group included 91 patients and the Low CT group included 88 patients.Then compared the operative time,stone-free(SF),and the complications status between the two groups.Results The age,male-female ratio,the stone size or the accompanying diseases between the low CT group and the high Hu group had no statistical difference(P>0.05).The average operative time of the two groups was(43±23)min and(50±25)min,respectively,which had statistical difference respectively(P<0.05);the incidence of complications was 3.3%and 6.8%,respectively,which had no statistical difference(P<0.05);the SF was 94.6%and 93.2%,respectively,which had no statistical difference(P>0.05).Conclusions FURS for the upper ureteral calculi,with calculi size<20 mm,was safe and effective;the Hu of calculi above 800 Hu could extend operative time and reduce lithotripsy efficiency.Preoperative evaluation of Hu value of patients,to a certain extent,could help the urologists to evaluate incidence of postoperative complications and grasp the difficulty and the risk of surgery.