Application of CT in the Diagnosis of Nephrolithiasis Complicated with Pyonephrosis and Preoperative Localization

doi:10.7517/issn.1674-0475.220315

Abstract

Abstract: This study investigated the application value of CT in the diagnosis of calculous pyonephrosis and preoperative localization. Selected 165 patients with nephrolithiasis complicated with pyonephrosis who were to undergo surgical treatment through randomized clinical study mode, all patients underwent CT examination before surgery. Using surgical results as the gold standard, among them 78 patients were diagnosed with nephrolithiasis complicated with pyonephrosis, and 87 cases were not with nephrolithiasis, analyzed the value of of CT in the diagnosis of nephrolithiasis complicated with pyonephrosis. According to the way of preoperative positioning of stones, the 78 patients with pyonephrosis were divided into CT group with 39 cases (preoperative CT localization) and ultrasound group with 39 cases (preoperative ultrasonic localization) and then compared the influence of two preoperative positioning methods on the surgical outcome. The results showed that the CT value, peripheral white blood cells (WBC), and C-reactive protein (CRP) of the kidney stone combined with pus kidney group were significantly higher than those of the kidney stone group (P<0.05). The sensitivity of CT value, WBC and CRP in the diagnosis of nephrolithiasis complicated with pyonephrosis were 87.81%, 72.57%, and 77.96%, respectively, and the specificity was 82.60%, 76.04%, and 75.75%, respectively,the AUC values were 0.904, 0.759, and 0.810, respectively. The mean operation time, mean lithotripsy time, and hemoglobin (Hb) decrease in the CT group were lower than those in the ultrasound group (P<0.05), the stone clearance rate in the CT group was higher than that in the ultrasound group (P<0.05). There was no significant difference in hospitalization time between the CT group and the ultrasound group (P>0.05). Preoperative CT examination has higher diagnostic sensitivity in patients with renal calculi and pyonephrosis, and CT can be used for calculus localization, and the localization effect is better than ultrasound localization.

Key words: CT, nephrolithiasis, pus kidney, localization, percutaneous nephrolithotomy

LIAO Shubin, YANG Dongshen, SU Xiaolin. Application of CT in the Diagnosis of Nephrolithiasis Complicated with Pyonephrosis and Preoperative Localization[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(4): 725-729.

References

[1] 陈红兵, 罗英女. 多层螺旋CT多期扫描对肾占位性病变的诊断及鉴别诊断价值探讨[J]. 中国CT和MRI杂志, 2020,18(6):115-117, 139.
[2] 陶水祥, 张关富, 沈翀, 等. 结石CT值测定联合输尿管软镜治疗大负荷肾结石[J]. 中国微创外科杂志, 2020,20(3):234-236.
[3] 吴俊, 陈红燕, 姬胜杰. 输尿管结石急性肾绞痛泌尿系CT影像特征分析[J]. 山东医药, 2019,59(16):60-62.
[4] 邓耀良, 叶章群, 李虹. 泌尿系结石临床诊断治疗学:从指南到临床[M]. 北京:人民卫生出版社, 2009.
[5] 崔守玉, 刘奔. 上尿路结石CT值预测结石成分在体外冲击波碎石术治疗中的临床应用[J]. 陕西医学杂志, 2019,48(8):997-999, 1016.
[6] 刘余庆, 邱敏, 刘可, 等. 一期输尿管软镜联合经皮肾镜治疗鹿角形结石合并脓肾的疗效和安全性[J]. 中华泌尿外科杂志, 2020,41(4):267-271.
[7] 张艳, 李纲. 全体积CT纹理分析在泌尿系结石的临床应用研究[J]. 临床泌尿外科杂志, 2021,36(7):543-548.
[8] 李帛, 武国军, 李振宇, 等. 输尿管支架在恶性肿瘤引起的输尿管梗阻治疗中的应用新进展[J]. 中华腔镜泌尿外科杂志(电子版), 2020,14(4):316-320.
[9] 茅善华. 泌尿系结石相关梗阻性肾病的临床特征调查以及雌激素对其发展影响的相关研究[D]. 上海:复旦大学, 2013.
[10] 王田, 洪欣, 柳青, 等. 一期经尿道输尿管镜碎石术治疗输尿管结石继发隐匿性梗阻性肾积脓的疗效和安全性[J]. 中华泌尿外科杂志, 2020,41(11):846-850.
[11] 张锋, 徐英进, 魏巍, 等. 肾脏肿瘤患者CT灌注参数与肾功能生化检测指标的相关性研究[J]. 现代生物医学进展, 2018,18(16):3153-3156.
[12] 覃天资, 黄群, 黄敏玉, 等. C-反应蛋白在上尿路结石梗阻性脓肾中的表达及其危险因素分析[J]. 临床泌尿外科杂志, 2020,35(8):651-654, 657.
[13] 江雪峰, 陈弋生, 陶凌松, 等. 输尿管结石梗阻合并糖尿病引发肾积脓18例临床分析[J]. 临床外科杂志, 2020,28(1):97-98.
[14] 邢健生, 白志明. 单侧输尿管梗阻引起输尿管损伤的新认知及进展[J]. 局解手术学杂志, 2015,24(4):447-450.

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