| BackgroundUrinary stone disease,as a common disease in urology,seriously affects the health and quality of the life of patients.Common methods for analyzing the composition of stones include thermogravimetric analysis,chemical qualitative analysis,quantitative analysis,polarizing microscope and spectral analysis.However,these common methods have some shortcomings in that they are time-consuming,difficult to operate,less accurate and only limited to extracorporeal stones.Therefore,how to use imaging methods to determine the composition of the stones quickly,accurately and non-inclusively has always been the focus of research.ObjectiveTo explore the clinical value of dual source CT in predicting the composition of upper urinary tract stones and guiding clinical individualized treatmentMethodThe first part,based on a retrospective case study,selected 146 patients with upper urinary tract calculi received by our hospital from January 2019 to January 2020 who underwent dual-source CT and infrared spectroscopy stone analysis,and evaluated the consistency of dual-source CT and infrared spectroscopy in stone composition determination.These 146 patients are group A.In the second part,a prospective case study was used to select 146 patients with upper urinary tract calculi received by our hospital from January 2021 to January 2022 who underwent dual-source CT examination as group B.And in group B we only judged stones by dual-source CT Composition,choose treatment(extracorporeal shock wave lithotripsy or URL)based on stone composition.Then,The treatment is successful if there is no residual stone in the ureter and the residual stone in the kidney is less than 4mm after one month of treatment。the effects of the patients who received extracorporeal shock wave lithotripsy or URL in group A and group B were compared in terms of their treatment time,treatment success rate,hospitalization time,postoperative complication rate,inflammatory index,hemodynamic index,renal function index and quality of life.Result1.Sensitivity and specificity of dual source CT in the diagnosis of stone components:Taking infrared spectrum as the gold standard,DSCT has 100%sensitivity,100%specificity,75.95%sensitivity and 69.35%specificity in uric acid and non uric acid stones;The sensitivity and specificity of phosphate stones were 74.15%and 90.65%,respectively;The sensitivity of cystine stone was 64.65%,and the specificity was 85.16%.2.The statistical results of basic treatment indicators:the treatment time of group B was(50.3±6.3)minutes,the operation success rate was 98.93%,and the hospitalization time was(4.0±1.3)days;the treatment time of group A was(53.8±6.0)minutes,and the operation success rate was 94.27%,hospital stay(3.8±1.1)days.Statistical analysis showed that the treatment time of group B was significantly shorter than that of group A(t=16.953,P=0.001),and the success rate of treatment in group B was significantly higher than that in group A(x~2=9.862,P=0.013).There was no significant difference in time between groups(P>0.05).3.Statistics on the incidence of complications:the postoperative complication rate of group A was 28.08%,and the postoperative complication rate of group B was 22.60%.The incidence of complications in group B was significantly lower than that in group A,and the difference between groups was statistically significant.(x~2=18.761,P<0.001).4.Statistical results of inflammatory indicators after treatment:the indexes of postoperative inflammatory factors in the B group were IL-6(13.52±2.03)pg/ml and TNF-α(3.17±0.70)ng/ml、CRP(22.58±2.55)mg/l;The corresponding three indexes of the A group were:(13.75±1.97)pg/ml and TNF-α(3.30±0.94)ng/ml and CRP(23.06±2.68)mg/L,there was no significant difference between the groups(P>0.05).5.Statistical results of renal function indexes after treatment:the postoperative renal function indexes of the B group were bun(6.73±1.05)mmol/L and SCR(80.05±5.42)μMol/L,the corresponding two indexes of the A group were(6.75±1.11)mmol/L and(79.79±6.11)mmol/L respectivelyμmol/L。6.Statistical results of hemodynamic indexes after treatment:in the B group,HR(74.7±2.2)times/min,map(11.8±0.8)k Pa and CVP(0.80±0.32)k Pa;The corresponding three indexes of the A group were:(75.1±2.7)times/min,(12.0±1.0)k Pa and CVP(0.82±0.38)k Pa.There was no significant difference between the groups(P>0.05).7.The statistical results of postoperative quality of life and the score of SF-36 showed that there was no significant difference between the two groups in the scores of physical function,role limitation caused by health,pain,overall health,vitality,social function,role limitation caused by emotion and mental health(P>0.05).Conclusion1.Dual source CT has a good effect in the component analysis of upper urinary tract calculi,and can provide effective guidance for the selection of clinical treatment of upper urinary tract calculi.2.Dual source CT can improve the success rate of treat,shorten the treatment time,improve the utilization rate of medical resources,and reduce the incidence of symptoms on the basis of ensuring the treatment effect of upper urinary tract stones.It has high clinical applicability. |
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