| Background:Urinary calculus is a common surgical disease in urinary system,the reason of which is complicated and varied.Urinary calculus is liable to cause urinary tract obstruction,which could induce urinary tract infection or injury,accompanied with symptoms such as dull pain or colic pain in waist,hematuria and fever et al.Urinary calculus is a common and frequently occurring disease,which has a serious impact on patient's living quality.Ultrasound is an important imageological method for diagnosing urinary calculus,which is widely used for its precise diagnosis,simple operation,noninvasive process and low price.Ultrasound diagnoses urinary calculus according to hyperecho mass,and acoustic shadowing(AS)and twinkling artifact accompany it are important diagnostic evidence.Non-contrast helical computerized tomography(NCHCT)is the golden standard for urinary calculus diagnosis.As an imageological examination widely used in clinic,NCHCT could obtain precise messages such as calculus location,size and amount,make a preliminary estimation of the hardness and fragility of urinary calculus,and calculate accurately the volume of the calculus by establishing three-dimensional reconstruction model,which has high sensitivity and specificity in diagnosing urinary calculus.Holmium laser is one of the most advanced laser devices in numerous laser devices applied in surgery.Because of its precise and powerful fragmentation and high security,Holmium laser lithotripsy has become one of the most popular treatments for urinary calculus.However,the total energy of Holmium laser lithotripsy is affected by many factors,and there is much difference in the energy of lithotripsy for different calculi.There is some deficiency in unguided energy in the lithotripsy,and insufficient or overused energy could both have harmful effect on the operation.Therefore,evaluating the total energy of Holmium laser lithotripsy and guiding the use of the energy of lithotripsy has important clinical significance in estimating the difficulty of lithotripsy and improving the safety and efficiency of laser lithotripsy.The study was divided into two parts:Part I:The related parameters of urinary calculus were measured respectively by ultrasound and NCHCT,and the mathematical models correlating the parameters of the two examinations with the total energy of lithotripsy(TEL)were established.Part ?;Taking the established mathematical models as the object of study,the correlations between the parameters of ultrasound and NCHCT and the total energy of Holmium laser lithotripsy were compared and investigated,and the superiority of the two methods in evaluating the TEL was analyzed,in order to search for the best method for evaluating the total energy of Holmium laser lithotripsy.PART IStudy of the correlation between ultrasound and non-contrast helical computerized tomography and the total energy of Holmium laser lithotripsyObjective:The purpose of the study was to investigate the correlation between the parameters of ultrasound and NCHCT and the total energy of Holmium laser lithotripsy,and establish the mathematical models correlating the parameters of the two examinations with the TEL,in order to provide a foundation to estimate the TEL and guide the use of energy in Holmium laser lithotripsy,which could predict the difficulty of the lithotripsy and improve the safety and efficiency of laser lithotripsyMaterials and Methods:From March 2013 to February 2015,356 patients with urinary calculi and ready for Holmium laser lithotripsy were enrolled and randomly divided into ultrasound group and NCHCT group.In ultrasound group,patients were examined of the urinary system with ultrasound the day before the operation.Two-dimensional imaging was used to measure the longest diameter of the calculus and to confirm the calculus location and the level of AS behind the calculus.Color Doppler flowing imaging(CDFI)was used to assess the twinkling artifact behind the calculus.The twinkling artifact intensity(TAI)was quantified by calculating the number of color pixels in each artifact.In NCHCT group,patients were scanned of the urinary system with NCHCT the day before the operation.The CT images were extracted and the calculus location was confirmed,the CT value was measured,and the volume of the calculus in the established three-dimensional reconstruction model was calculated.The total energy of Holmium laser lithotripsy of all patients was recorded postoperatively.Statistical analyses were performed with the SPSS 17.0 software package.Spearman's rank correlation analysis was used in ultrasound group to assess the correlations between the TEL and the calculus location,longest diameter,AS level,and TAI;and in NCHCT group to assess the correlations between the TEL and the location,volume and CT value of the calculus.Multiple linear regression was performed to formulate mathematical models of the two groups to estimate the TEL.Results:Ultrasound group:1.There was difference between the TEL required for calculi of different locations(r=-0.565.P<0.001),and the TEL for renal calculus was higher than that for ureteral calculus.2.Statistical analysis showed correlation between the longest diameter of the calculus and the TEL(r=0.675,P<0.001),and larger calculus required higher TEL.3.There was difference in the TEL between different levels of AS(r=0.325,P<0.001),and calculus with AS required more energy of lithotripsy than calculus without AS.4.The TAI was correlated with the TEL(r=0.391,P<0.001),and higher TEL was required for calculus with greater TAI.To estimate the TEL of different calculi,a multiple linear regression model was established with the following parameters:calculus location,the longest diameter of the calculus,AS level and TAI.After collinearity was eliminated and normality was tested,the following multiple linear regression equation was obtained:TEL(J)=755.4xthe longest diameter of calculus(mm)-3099.4×location of calculus(1=renal calculus;2=ureteral calculus)+0.2×TAI(the number of color pixels)(F=58.644,adjusted r2=0.498,P<0.001).The equation showed that more energy was needed for lithotripsy in patient with larger calculus,renal calculus or calculus with greater TAI.NCHCT group:1.There was difference between the TEL required for calculi of different locations(r=-0.557,P<0.001),and the TEL for renal calculus was much higher than that for ureteral calculus.2.Statistical analysis showed strong correlation between the volume of the calculus and the TEL(r=0.778,P<0.001).Larger calculus required higher TEL.3.There was correlation between the CT value of the calculus and the TEL(r=0.407,P<0.001),and calculus with higher CT value required higher TEL.To estimate the TEL of different calculi,a multiple linear regression model was established with the following parameters:calculus location,volume,and CT value.After collinearity was eliminated and normality was tested,the following multiple linear regression equation was obtained:TEL(J)=-1558.313+8.398×calculus volume(mm3)-1162.743xcalculus location(1=renal calculus;2=ureteral calculus)(F=3682.220,adjusted r2=0.605,P<0.001).The equation showed that more energy was needed for lithotripsy in patient with renal calculus,calculus with larger volume or calculus with higher CT value.Conclusion:There were correlations between the parameters of ultrasound and NCHCT and the TEL.Mathematical models correlating the parameters of ultrasound and NCHCT with the TEL were established respectively,which may provide a foundation to guide the use of energy in Holmium laser lithotripsy.By providing a preliminary evaluation of the total energy required in Holmium laser lithotripsy,ultrasound and NCHCT could predict the difficulty of lithotripsy,improve the safety and efficiency of lithotripsy and has important clinical significance.PART IIComparative study of ultrasound and non-contrast helical computerized tomography in evaluating the total energy of Holmium laser lithotripsyObjective:The purpose of this study was to compare and investigate the correlations between the parameters of ultrasound and NCHCT and the total energy of Holmium laser lithotripsy,and analyze the superiority of the two methods in evaluating the TEL,in order to search for the best method for evaluating the total energy of Holmium laser lithotripsy.Materials and Methods:Taking the established mathematical models as the object of study,the related data of the parameters of the patients with urinary calculi in ultrasound group were put into the multiple linear regression equation correlating ultrasound with the TEL,and the evaluated lithotripsy energy was obtained.The subtraction between the actual lithotripsy energy and the evaluated lithotripsy energy was made,and the difference of lithotripsy energy evaluated by ultrasound was obtained.In the same way,the related data of the parameters of the patients with urinary calculi in NCHCT group were put into the multiple linear regression equation correlating NCHCT with the TEL,and the difference of lithotripsy energy evaluated by NCHCT was obtained.The two groups of differences of evaluated lithotripsy energy were compared to assess if there was difference between the mathematical model of ultrasound and NCHCT in evaluating the total energy of Holmium laser lithotripsy.Statistical analyses were performed with the SPSS 17.0 software package.T-test was used to compare the two groups of differences of evaluated lithotripsy energy.Results:The differences of lithotripsy energy evaluated by ultrasound(Dn=1020.73±2529.482)and NCHCT(dn=948.86±2035.981)were obtained by statistical analysis.Dn and dn were compared with t-test and there was no significant difference between the two groups of differences of evaluated lithotripsy energy(t=-0.2902,P>0.05).There was no significant difference between the mathematical models of ultrasound and NCHCT in evaluating the total energy of Holmium laser lithotripsy.Conclusion:Ultrasound and NCHCT had respective superiority in evaluating the total energy of Holmium laser lithotripsy,and there was no significant difference in the superiority of energy evaluation. |
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