大小并非一切：RIRS 术后结石清除率的术前 CT 预测因素。

Size is Not Everything That Matters: Preoperative CT Predictors of Stone Free After RIRS.

机构信息

Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Department of Radiology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

出版信息

Urology. 2019 Oct;132:63-68. doi: 10.1016/j.urology.2019.07.006. Epub 2019 Jul 13.

DOI:10.1016/j.urology.2019.07.006

PMID:31310774

Abstract

OBJECTIVE

To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal.

METHODS

From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CT using multiplanar reconstruction.

RESULTS

Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 ± 26.7 minutes (mean ± SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CT demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41° was associated with a higher chance of residual fragments after RIRS.

CONCLUSION

IPA < 41° is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm.

摘要

目的

在从未接受过结石取石手术的患者中，确定 20mm 以下肾结石行逆行肾内手术（RIRS）后残留结石碎片的 CT 预测因子。

方法

2016 年 8 月至 2017 年 8 月，对接受 RIRS 治疗的 20mm 以下肾结石症状性成年患者的术前和术后 CT 进行前瞻性评估，以寻找残留结石碎片的预测因子。在术前 CT 中评估结石大小、结石体积、结石数量、结石密度和位置，并将其分析为术后 90 天 CT 上残留结石碎片的预测因子。术前非增强 CT 采用多平面重建测量每个结石的肾盂漏斗角（IPA），代表结石位置。

结果

92 例患者成功接受 RIRS 治疗。23 例患者（25%）行双侧手术，共 115 个肾脏单位接受手术。手术时间为 54.5±26.7 分钟（平均值±标准差），96.7%（89/92）的患者在术后 12 小时内出院。术后 CT 显示 115 例中有 86 例（74.8%）结石清除，10 例（8.7%）结石直径为 0-2mm，19 例（16.5%）结石直径>2mm。Logistic 回归分析显示，陡峭的 IPA 是 20mm 以下肾结石行 RIRS 后存在任何残留结石碎片的预测因子（P=0.012）。ROC 曲线显示，IPA<41°与 RIRS 后残留结石碎片的可能性较高相关。