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目的研究螺旋CT对体内尿路结石化学成份的预测以及在体外震波碎石中的价值。方法选取本院2008年至2010年尿路结石患者117例,均在治疗前行螺旋CT平扫,测结石CT值并对治疗后获取的结石成分进行分析;选择结石大小适合体外震波碎石(ESWL)的患者,用结石CT值预测ESWL的结石粉碎率和排空率。结果所有结石的CT值为323～1 580 Hu。单一结石成分仅33例(28.21%),包括一水草酸钙、碳酸磷灰石、无水尿酸、二水磷酸氢钙和二水草酸钙结石,CT值分别为(693±128)Hu、(1 233±241)Hu、(368±38)Hu、1 580 Hu和73 Hu;混合性结石84例(71.80%),混合结石主要含两种化学成分,CT值在相应两种成分纯结石的CT值之间。一水草酸钙结石、碳酸磷灰石结石、无水尿酸结石、一水草酸钙+碳磷灰石结石、碳酸磷灰石+一水草酸钙结石、无水尿酸+碳磷灰石结石之间CT值的差异有统计学意义(P<0.01),一水草酸钙结石与一水草酸钙+二水草酸钙、六水磷酸镁胺+碳酸磷灰石之间CT值差异无统计学意义(P>0.05)。二水草酸钙结石和二水磷酸氢钙结石各1例,CT值为673 Hu和1 580 Hu,未参与统计分析。117例患者中结石排空者81例(69.23%),结石残留者36例(30.77%),其CT值分别为(754±146)Hu和(1 068±247)Hu,2者差异具有统计学意义(P<0.01)。结论结石CT值能在一定程度上预测体内尿路结石成分,而且还能预测体内尿路结石ESWL后结石的排空率和失败率。CT值低者则ESWL后结石容易粉碎和易于排空;CT值高者结石的粉碎率和排空率较低,此类患者可考虑选择输尿管镜下取石碎石术、经皮肾镜取石碎石术。
Objective To study the prediction of the chemical composition of urinary calculi by spiral CT and its value in extracorporeal shock wave lithotripsy. Methods Totally 117 patients with urolithiasis in our hospital from 2008 to 2010 were examined by spiral CT before treatment. The CT value of the stone was measured and the stone components obtained after the treatment were analyzed. The stone size suitable for extracorporeal shock wave lithotripsy ESWL) patients with stone CT value prediction ESWL stone crushing rate and emptying rate. Results The CT value of all stones was 323-1 580 Hu. 33 cases (28.21%) had single stone composition, including calcium oxalate monohydrate, carbonated apatite, anhydrous uric acid, calcium hydrogen phosphate dibasic and calcium oxalate dihydrate. The CT values were (693 ± 128) 1 233 ± 241) Hu, (368 ± 38) Hu, 1 580 Hu and 73 Hu; 84 cases of mixed stones (71.80%). The mixed stones mainly consisted of two kinds of chemical components. Between CT values. Calcium carbonate apatite stones, anhydrous uric acid stones, calcium oxalate monohydrate + carbon apatite stones, carbonate apatite + calcium oxalate stones, anhydrous uric acid + between carbon apatite stones CT value of the difference was statistically significant (P <0.01), calcium oxalate stones and calcium oxalate monohydrate calcium oxalate dihydrate, magnesium phosphate hexahydrate + carbonated apatite CT value difference was not statistically significant ( P> 0.05). One case of calcium oxalate stones and one case of calcium hydrogen phosphate dibasic stones each had CT values of 673 Hu and 1 580 Hu, which were not involved in statistical analysis. Of the 117 patients, 81 (69.23%) had stone-emptying, 36 (30.77%) had residual stones, and the CT values were (754 ± 146) Hu and (1 068 ± 247) Hu, respectively Significance (P <0.01). Conclusion CT value of stone can predict the composition of urinary tract stones in vivo to a certain extent, but also can predict the void rate and failure rate of stone after ESWL. CT value of the lower ESWL after the stone is easy to crush and easy to empty; high CT value of stone crushing rate and emptying rate is low, such patients may choose to take ureteroscopic lithotripsy, percutaneous nephrolithotomy stone broken Stone surgery.