| Objective:The CT value of renal calculi was measured by non enhanced spiral CT.The clinical data of the patients were analyzed retrospectively to determine the relationship between the CT value of the stone and the stone-free rate after ureteroscopic lithotripsy,and to explore whether the CT value of the calculi could predict the curative effect of FURL for the treatment of single renal calculi.Methods:Collected during January 2015-December 2017 in the first affiliated Hospital of Nanchang University urology clinic and accept FURL treatment,111 cases of single kidney stone patients information,the maximum diameter of calculi is 1-2cm.There were 68 male patients,43 cases of female patients,55 cases of right kidney stones,56 cases of left renal calculi,2 cases of upper renal calculi,5 cases of middle calculi,16 cases of calculi and 88 cases of renal pelvis calculi.All patients were treated with Toshiba Aquilion 64 slice spiral not enhanced CT at 120 kV,125mAs before operation in our hospital.The scanning layer is 5mm thick and the interval is 5mm.The maximum diameter and mean CT value of stones were measured in the soft tissue window(360 HU window width,60 HU window position)(expressed by Hounsfield Unit).According to the average CT value measured,it was divided into group A(CT value < 800 HU,n=58)and group B(CT value > 800 HU,n=53).A and B groups were divided into A1(maximum diameter ≤ 1.5cm,n=35)and A2(maximum diameter >1.5cm,n=23),B1(maximum diameter ≤ 1.5cm,n=25),B2(maximum diameter >1.5cm,n=28).according to whether the maximum diameter of the stone was greater than 1.5cm.Preoperative examination suggested that patients with urinary tract infection standardize the use of antibiotics to fully control urinary tract infection and have no clear urinary tract infection,Routine prophylactic antibiotics are used thirty minutes before operation.During the operation,high frequency(40Hz)and low energy(0.6j)were used to nibble away the stone to powder the stone to the maximumextent.The differences of stone-free rate,operation time,hospital stay and complication rate were compared in each group one month after operation.Results:A total of 111 patients were included in the study.The stone removal rate was82.88%(92/111)in the first month after surgery,and the incidence of total complications was 15.32%(17/111).The mean CT value of group A was significantly lower than that of group B(P < 0.05).The operative time of group A was significantly shorter than that of group B(P < 0.05).One month after surgery,the stone removal rate of group A was higher than that of group B(P=0.013),and the difference was statistically significant.A1 and A2 group compared with operation time group A1 was obviously shorter than group A2,difference was statistically significant(P < 0.05),A1group(97.14%),postoperative calculi clearance rate is higher than group A2(82.61%),group A1(8.57%),lower incidence of postoperative complications than group A2(17.39%).B1 and B2 group compared with operation time B1 group was obviously shorter than B2,B1 group(88%)in postoperative calculi clearance rate is significantly higher than group B2(60.71%),the difference was statistically significant(P < 0.05),B1 group(16%),lower incidence of postoperative complications than group B2(21.43%).A1 and B1 group compared to the operation time group A1 significantly shorter than B1 group difference was statistically significant(P < 0.05),A1 group(97.14%),postoperative calculi clearance rate is higher than B1(88%),A1 group(8.57%),lower incidence of postoperative complications than B1(16%).A2 and B2 group compared to the operation time group A2 significantly shorter than the B2 group difference was statistically significant(P <0.05),A2 group(82.61%),postoperative calculi clearance rate higher than the B2group(60.71%),A2(8.57%),lower incidence of postoperative complications B2group(16%).Conclusion:1.FURL is a safe and effective way to treat kidney stone with diameter of 1-2cm,high-definition stone rate(82.88 %),small operative trauma,short hospitalization time,fast recovery and less complications.2.When the diameter of the stone is the same,the power of holmium laser lithotripsy is the same,the gravel time and postoperative complications increase with the increase of the CT value of the stone,and the stone clearance rate decreases with the increase of CT value of the stone.When the CT value of stone is the same,holmium laser lithotripsy power is the same,the time of lithotripsy and postoperative complications increase with the increase of the maximum diameter of calculi,and the removal rate of calculi decreases with the increase of the maximum diameter of calculi. |
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