2～3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值

目的探讨结石CT值对输尿管软镜联合钬激光治疗较大负荷肾盂结石（2～3 cm）手术的评估和预测作用。 方法回顾收集2016年1月至2017年9月符合标准的输尿管软镜钬激光碎石术病例与影像学资料，依结石CT值分为<700 HU、700～1 000 HU及>1 000 HU三组，观察并比较各组间结石大小、一期手术时间、结石清除率等。 结果共纳入病例68例，均顺利完成手术，各组结石大小差异无统计学意义。CT值<700 HU组（n=20）与700～1 000 HU组（n=25）手术时间分别为（85±19）min和（93±21）min，一期结石清除率分别85.0%和76.0%，两组差异无统计学意义（P>0.05）；>1 000 HU组（n=23）平均手术时间（103±13）min，较其他两组更长（P<0.05），一期结石清除率47.8%，亦相对更低（P<0.05）。 结论术前CT测算结石HU值对输尿管软镜治疗2～3 cm肾盂结石手术效果预估作用可靠，1 000 HU以下肾盂结石应用该术式可较快完成手术并获得较高结石清除率。

The application value of CT hounsfield unit for flexible ureteroscopic lithotripsy in the treatment of renal pelvis calculi (2-3 cm)

ObjectiveTo investigate the role of CT values of calculi in evaluation and prediction of surgical efficacy of flexible ureteroscope combined with holmium laser lithotripsy in the treatment of renal pelvic calculi (2-3 cm). MethodsClinical and imaging data of pelvic calculi patients receiving flexible ureteroscope and holmium laser lithotripsy from January 2016 to September 2017 were retrospectively analyzed. According to the CT values of calculi, all patients were divided into the <700 HU, 700-1 000 HU and >1 000 HU groups. The size of calculi, the first-stage operation time and the removal rate of calculi were observed and compared. ResultsA total of 68 cases were included and all patients successfully completed the operation. The size of calculi did not statistic differ among different groups. In the <700 HU (n=20) and 700-1 000 HU groups (n=25), the operation time was (85±19) min and (93±21) min, and the first-stage removal rates of calculi were 85.0% and 76.0% with no statistical significance between the two groups (both P>0.05). In the >1 000 HU group (n=23), the average operation time was (103±13) min, significantly longer than that in the other two groups (both P<0.05). The first-stage removal rate of calculi was 47.8%, significantly lower compared with those in the 700-1 000 HU and <700 HU groups (both P<0.05). ConclusionPreoperative measurement of CT values of calculi is reliable in predicting the surgical efficacy of flexible ureteroscope in treating 2-3 cm pelvic calculi. Flexible ureteroscope in combination with holmium laser lithotripsy is an efficacious treatment of pelvic calculi with CT values of below 1 000 HU, which yields a relatively high removeal rate of pelvic calculi.