新型定位方式在体外冲击波碎石术治疗输尿管中段结石中应用研究

Application of a new localization method in extracorporeal shock wave lithotripsy in treatment of middle ureter⁃al calculi

目的探讨彩色多普勒快闪伪像及高度充盈膀胱辅助下的新型定位方式在体外冲击波碎石术(ESWL)治疗输尿管中段结石中的应用价值。方法选取166例确诊的单侧输尿管中段结石患者,所有患者均拟行超声定位的ESWL,分别采用普通B超的定位法(A定位法)、彩色多普勒闪烁伪像辅助的彩超定位法(B定位法)、彩色多普勒闪烁伪像辅助联合充分充盈膀胱的定位法(C定位法),并分别记录A、B、C定位法的可定位患者定位成功率,比较三种定位方式定位成功率的差异。选取B、C定位法均可定位的患者104例,随机分为两组,观察组52例行ESWL时膀胱充分充盈,对照组52例行ESWL时膀胱不充盈,比较两组患者ESWL术后2周的治疗效果及并发症发生率情况。结果A定位法定位成功率45.78%(76/166),B定位法定位成功率65.66%(109/166),C定位法定位成功率89.76%(149/166)。三种定位方式定位成功率比较,差异有统计学意义(χ2=43.68,P<0.05)。观察组治疗总有效率为92.31%(48/52),对照组治疗总有效率为71.15%(37/52),两组间比较,差异有统计学意义(χ2=7.79,P<0.05);对照组、观察组并发症总发生率分别为69.23%(36/52)、63.46%(33/52),两组比较,差异无统计学意义(χ2=0.39,P>0.05)。结论超声定位的ESWL治疗输尿管中段结石时,充分充盈膀胱并应用彩色多普勒快闪伪像辅助下的改进定位方式,既可以提高结石定位率,又可以提高ESWL的疗效,且不会增加并发症的发生率。

Objective To explore the value of a new localization method assisted with color doppler flash artifacts and highly filled bladder in extracorporeal shock wave lithotripsy(ESWL)in treatment of middle ureteral calculi. Methods Totally 166 patients with unilateral middle ureteral calculi were selected.All patients were scheduled to undergo ultrasound-localized extracorporeal shock wave lithotripsy(ESWL).The localization method of common ultrasound(defined as A localization method),color doppler ultrasound localization method assisted by the color doppler scintillation artifact(defined as B localization method)and the combination of color doppler twinkling artifact and full filling of bladder localization method(defined as C localization method)were used respectively.The localization success rates of patients with A,B,and C localization methods were recorded and compared respectively.The 104 patients who could be located by both of B and C localization methods were randomly divided into two groups.In the observation group,the bladder was fully filled before ESWL,while in the control group,the bladder was not filled before ESWL.The therapeutic effect and the incidence of complications were compared between the two groups at 2 weeks after ESWL. Results The localization success rates of A,B,C localization method were 45.8%(76/166),65.66%(109/166),and 89.76%(149/166),respectively.There was significant difference in the success rate among three localization methods(χ2=43.68,P<0.05).The total effective rates of observation group and control group were 92.31%(48/52),71.15%(37/52).The difference was statistically significant (χ2=7.79,P<0.05).The total incidence of complications in the control group and the observation group were69.23%(36/52)and 63.46%(33/52),respectively.There was no significant difference between the two groups(χ2=0.39,P>0.05). Conclusion In the treatment of middle ureteral calculi with ultrasonic localization extracorporeal shock wave lithotripsy,the improved localization method assisted by color Doppler flash artifact can not only improve the localization rate of stones,but also improve the curative effect of ESWL,and does not increase the incidence of complications.