| Objective: To determine the composition of stones by spectroscopic CT on the atomic number of kidney stones,and to screen out cases of uric acid stones,calcium oxalate dihydrate stones,and struvite(magnesium ammonium phosphate stones)that can be easily broken by extracorporeal shock wave lithotripsy.The use of common methods to diagnose kidney stones and screened cases of kidney stones in extracorporeal shock wave lithotripsy.At the same time,the correspondence between the atomic number and the corresponding CT value of the different components of kidney stones determined by energy spectrum CT was summarized.The basic medical units that are in favor of no energy spectrum CT equipment can also judge the composition of kidney stones through the comparison of the data,and thus select the best treatment plan for cases of kidney stones.Avoid the damage to the kidneys caused by blind stones.Achieve the increase in the efficiency of extracorporeal shock wave lithotripsy,save treatment costs,shorten treatment time,and explore a new method to improve the therapeutic effect of extracorporeal shock wave lithotripsy(ESWL).It provides reference for the choice of treatment plan for the treatment of kidney stones by clinical staff.Methods: A total of 80 patients with single-item kidney stones with indications of extracorporeal shock wave lithotripsy in our hospital from March 2016 to June 2017 were selected as study subjects.The principle of voluntary shock wave lithotripsy was adopted.According to the study design.The protocol was divided into two groups,A and B.Group A was a control group: 40 patients with kidney stones diagnosed by KUB,B-ultrasonography,and conventional CT scans were routinely diagnosed.Group B is the observation group: using energy spectrum CT to diagnose and determine the stone atomic number,determine the composition of stones,and select uric acid stones,calcium oxalate dihydrate,and struvite(ammonium magnesium phosphate stones)from the shock-wave lithotripter.Broken case 40 cases.Given the same energy and frequency of extracorporeal shock wave lithotripsy treatment,the age,weight,stone site,stone size,renal function before and after lithotripsy,and the number and time of first row of stones were calculated.Group B was required to record the atomic number and CT value of different components of the stone.Assess the success rate of disposable lithotripsy in A and B groups;take ESWL treatment three times Success rate,follow-up need to take a further percentage of the number of surgical treatment,the total incidence of complications after lithotripsy,total healing time;total treatment costs.Efficacy criteria of ESWL: 1 stone exhaust net: CT scan of urinary system,plain abdominal film(KUB)or ultrasound shows no stone particles in vivo;2 complete comminution: urinary CT scan,KUB or ultrasound shows the length of residual stone <4mm;3 Partial comminution: The urinary CT scan,KUB or ultrasound showed little change in the main body of the stones.Results: There was no significant difference in age,sex,body weight,stone location,stone size,and preoperative renal function between the two groups,P>0.05.The average CT value of stones(78.18±106 hu in the observation group and 1487.43±186 hu in the control group,the difference was statistically significant,P<0.05).The observation group was subjected to energy spectrum CT to determine the attributive and CT values of the stones.The stones were composed of uric acid,magnesium ammonium phosphate and calcium oxalate dihydrate calculi in 40 cases,including 8 cases of uric acid stones,with an average atomic number of 6.94±2.84,an average CT value of 554.25±67.13 hu,and 14 cases of magnesium ammonium phosphate stones.The ordinal number was 8.33±1.98.The average CT value was 751.16±153.12 hu.There were 28 cases of calcium oxalate dihydrate with an average atomic number of 9.21±2.78.The average CT value was 905.46±87.43 hu.The comparison between the average atomic number of the friable stones in the observation group and the mean CT value was P<0.05,and the difference was statistically significant.The larger the average atomic number of brittle kidney stones,the larger the corresponding mean CT value.The total effective rate after a gravel(stone net discharge rate,complete crushing rate,partial crushing rate)was 90% in the observation group and 75% in the control group,the difference was statistically significant(P<0.05).The control group was 2.46±0.62 h,and the observation group was 1.16 ± 0.38 h.The difference was statistically significant,P<0.05.Three times the success rate of ESWL treatment was achieved.Of the 40 patients in the control group,34 patients(85%)received successful ESWL treatment,and 40 patients in the observation group received 38 ESWL treatment successes(95%),observation group was significantly higher than the control group,P <0.05,with statistical significance.Follow-up need to further take the number of surgical treatment,the control group to take further surgical treatment of patients with 6(15%),observation group to take further surgical treatment of patients with 2(5%),the observation group was significantly lower The control group,P<0.05,was statistically significant.Serum creatinine Cr was measured 1 day before ESWL in both groups,and it was 106.87±11.18umol/L in the control group and 105.65±15.58umol/L in the observation group.P>0.05,there was no statistical difference between the two groups,serum creatinine Cr 7 days after gravel,the control group was 149.36±30.42umol/L,the observation group was 136.23±21.14umol/L.P<0.05,with statistical difference.The serum creatinine Cr after 14 days of gravel was 126.36±13.46umol/L in the control group and 108.93±15.75umol/L in the observation group.P<0.05,with statistical difference.The serum creatinine Cr in the control group was 99.53±10.53umol/L at 21 days after gravel,and 93.67±9.38umol/L in the observation group.P>0.05,there was no statistical difference between the two groups.The total incidence of complications after lithotripsy in the control group was 27.5%.The total incidence of complications after lithotripsy in the observation group was 10%.The observation group was significantly lower than the control group,P<0.05,with statistical significance.The total treatment time in the control group was 25.28 ± 1.72 days,and the total cure time in the observation group was 21.42±0.58 days.The observation group was lower than the control group,the difference was statistically significant,P<0.05.The total treatment cost of the control group was 1.21 ± 0.34 million,the total treatment cost of the observation group was 0.43 ± 0.26 million,the observation group was lower than the control group,the difference was statistically significant,P <0.05.Conclusions: 1.Before ESWL,the stone atomic number and CT value were determined by energy spectrum CT on patients with kidney stones.Stone composition was determined and the hardness of stones was evaluated.Screening patients eligible for ESWL can improve the one-time success rate of ESWL.Patients with kidney stones that are not easily treated with extracorporeal shock wave lithotripsy can directly select other more effective treatment options such as laparoscopy or open surgery to avoid damage to the kidney caused by blind lithotripsy.2.Uric acid stones,calcium oxalate dihydrate and struvite(ammonium magnesium phosphate stones)are easy to shock wave lithotripsy in vitro.The average atomic number and CT value of uric acid stones were determined by energy spectrum CT.The average atomic number was 6.94±2.84.The value of 554.25±67.13 hu,magnesium ammonium phosphate stone,average atomic number 8.33±1.98,average CT value 751.16±153.12 hu,calcium oxalate dihydrate stone,average atomic number 9.21±2.78,average CT value 905.46±87.43 hu.The larger the mean atomic number of kidney stones that can be measured by spectrum CT,the larger the corresponding mean CT value is,and the positive correlation is between the two.There is no energy spectrum CT for guiding primary medical units,and only ordinary CT is selected.Crushing stones improve the therapeutic effect of ESWL.3.ESWL in patients with kidney stones undergoing spectral CT screening can reduce overall treatment costs,time,and complications after lithotripsy. |
PDF Full Text Request