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目的 :评估多层CT扫描(multi-slice computed tomography,MSCT)中平均结石密度(mean stone density,MSD)及皮肤结石距离(skin-to-stone distance,SSD)改变与肾输尿管结石体外超声碎石(extracorporeal shockwave lithotripsy,ESWL)疗效的相关性。方法:拟行ESWL的肾输尿管结石患者共66例,其中输尿管结石24例,肾结石42例,结石长径5~20 mm,所有患者均先行非增强MSCT检查,测量结石的MSD及SSD,并行碎石术;2周后影像复查,结石消失或者残留部分小结石且最大径<4 mm,判定ESWL有效。结果:66例肾输尿管结石行ESWL,有效成功率60.6%。碎石有效组与无效组的MSD分别为(599±124)HU和(946±259)HU,差异有统计学意义(P<0.001)。碎石有效组与无效组的SSD分别为(95.6±11.9)mm和(109.0±15.0)mm,差异无统计学意义。其中42例肾脏结石患者ESWL有效组和无效组的SSD分别为(91.9±8.2)mm和(100.4±13.4)mm,两组差异有统计学意义(P<0.001)。结论:ESWL术前行MSCT检查测定结石的MSD、SSD可以显著提高ESWL的成功率。肾输尿管结石的MSD<550 HU,行ESWL成功率高;MSD>850 HU,行ESWL成功率低。肾结石患者SSD越小,碎石成功率越高。
Objective: To evaluate the relationship between mean stone density (MSD) and skin-to-stone distance (SSD) in multi-slice computed tomography (MSCT) and renal ultrasonography (extracorporeal shockwave lithotripsy, ESWL) efficacy. Methods: A total of 66 patients with ESWL were enrolled in this study. Among them, 24 were ureteral stones, 42 were kidney stones and 5 ~ 20 mm in diameter. All patients underwent non-enhanced MSCT and MSD and SSD were measured in parallel Lithotripsy; 2 weeks after the image review, the disappearance of stones or residual part of the small stones and the largest diameter <4 mm, to determine ESWL effective. Results: 66 cases of renal ureteral calculi ESWL, the effective success rate of 60.6%. The MSD of gravel in effective group and ineffective group were (599 ± 124) HU and (946 ± 259) HU respectively, the difference was statistically significant (P <0.001). The SSDs of the gravel effective group and the ineffective group were (95.6 ± 11.9) mm and (109.0 ± 15.0) mm, respectively, with no significant difference. The SSD of ESWL effective group and ineffective group were (91.9 ± 8.2) mm and (100.4 ± 13.4) mm respectively in 42 patients with kidney stones, the difference between the two groups was statistically significant (P <0.001). Conclusion: ESWL preoperative MSCT examination of stone MSD, SSD can significantly improve the success rate of ESWL. Kidney ureteral calculi MSD <550 HU, line ESWL high success rate; MSD> 850 HU, line ESWL success rate is low. The smaller the SSD of kidney stones, the higher the success rate of gravel.