Pires Christophe, Machet Frédéric, Dahmani Laurent, Irani Jacques, Dore Bertrand
Service d'Urologie, CHU La Milétrie, 86021 Poitiers.
Prog Urol. 2003 Sep;13(4):581-4.
Evaluation of possible residual fragments after percutaneous nephrolithotomy is an essential aspect of the management of stone disease. The results of this evaluation determine the therapeutic approach, follow-up and presumed duration of treatment. The imaging modalities most frequently used are non-enhanced spiral computed tomography and plain abdominal x-ray. The objective of this study was to evaluate the contribution of spiral CT to the immediate follow-up of percutaneous nephrolithotomy.
Over a period of two years, we prospectively included 50 patients in whom plain abdominal x-ray and spiral CT were performed on the first postoperative day after percutaneous nephrolithotomy. The diagnosis of residual fragments was based on these examinations by 2 independent radiologists.
The sensitivity for the detection of residual fragments was 87% for plain abdominal x-ray compared 100% for computed tomography. 89% of the fragments not diagnosed by plain abdominal x-ray were less than 5 min.
Plain abdominal x-ray was insufficient for the diagnosis of small residual fragments. Spiral CT is justified to confirm the absence of residual fragments in a patient after percutaneous nephrolithotomy despite the higher cost and irradiation compared to plain abdominal x-ray.
经皮肾镜取石术后对可能残留结石碎片的评估是结石病治疗管理的重要环节。该评估结果决定了治疗方法、随访及预期治疗时长。最常使用的成像方式是平扫螺旋计算机断层扫描和腹部平片。本研究的目的是评估螺旋CT在经皮肾镜取石术后即刻随访中的作用。
在两年时间里，我们前瞻性纳入了50例经皮肾镜取石术后第一天接受腹部平片和螺旋CT检查的患者。由两名独立放射科医生根据这些检查结果诊断残留结石碎片。
腹部平片检测残留结石碎片的敏感性为87%，而计算机断层扫描为100%。腹部平片未诊断出的碎片中，89%小于5毫米。
腹部平片不足以诊断小的残留结石碎片。尽管与腹部平片相比成本更高且辐射更大，但螺旋CT对于确认经皮肾镜取石术后患者无残留结石碎片是合理的。
