螺旋CT值对肾结石采用第五代EMS碎石的临床价值研究

The clinical value of spiral CT value in renal calculi treated with the fifth-generation EMS

目的通过术前螺旋CT值对肾结石结石成分进行预测,根据结石成分预测结果采用第五代EMS进行碎石取石术,同时对第五代EMS针对不同结石成分的碎石效果进行评估。方法 328例肾结石患者,进行术前肾结石的螺旋CT值测定,根据螺旋CT值预测肾结石成分,采用第五代EMS经皮肾镜碎石取石术进行碎石,观察结石清除率。结果 328例患者结石硬度由大到小依次为磷酸钙结石>碳酸磷灰石>草酸钙结石>胱氨酸结石>磷酸镁铵结石>尿酸结石。第五代EMS对大多数肾结石均具有良好的效果。对胱氨酸结石、磷酸铵镁结石、尿酸结石效果较好;对结石内含有基质成分碎石效果一般,配合钳夹较好;对磷酸钙结石硬度很大的结石,碎石效果差,配合钬激光比单纯应用EMS效果好。结论螺旋CT值对肾结石患者采用第五代EMS碎石具有一定的临床预测价值。

Objective To predict the composition of renal calculi, based of which the fifth-generation EMS was used to perform lithotripsy. At the same time, the effect of the fifth-generation EMS on different calculi components was evaluated. Methods 328 patients with renal calculi were measured by spiral CT before operation. According to the spiral CT value, the components of renal calculi were predicted. The fifth generation EMS percutaneous nephrolithotomy was used for lithotripsy, and the calculi clearance rate was observed. Results The order of calculi hardness in 328 patients was calcium phosphate stone> carbonate apatite> calcium oxalate calculi > cystine calculi > magnesium ammonium phosphate calculi > uric acid calculi. The fifth-generation EMS has good effect on most renal calculi. It has a good effect on cystine calculi, magnesium ammonium phosphate calculi and uric acid calculi;it has a general effect on calculi containing matrix components and is better with clamp;it has a poor effect on stones with high hardness of calcium phosphate calculi, and the effect with holmium laser is better than that of EMS alone. Conclusion The value of spiral CT has certain clinical predictive value for fifth-generation EMS lithotripsy of renal calculi patients.