静脈内視鏡検査は,真空補助式石除粉療法における石のない状態の評価のために,手術後の低用量CTを代用できますか?
Qi Liu1, Junkai Huang1, Jian Li1
1Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
World journal of urology
|September 3, 2025
まとめ
術内内視鏡検査は,小型の石の真空補助型リトトリプシー後の石抜き状態を正確に確認し,一部の患者では低用量コンピュータトモグラフィー (LDCT) の必要性を減少させる可能性があります. しかし,LDCTは,より大きな石や高リスクのケースに不可欠です.
科学分野:
- 泌尿器科
- エンドウロロジー
- 医療用イメージング
背景:
- リトトリプシー後の石抜き状態 (SFS) の決定は,治療の成功にとって極めて重要です.
- 低用量コンピューティングトモグラフィー (LDCT) は,SFS評価の現在の標準です.
- 放射線被曝とコストを減らすための 潜在的代替手段を内視検査で提供しています
研究 の 目的:
- 逆行式真空補助除塵リトトリプシー (VADL) の後,SFSのための術内内視鏡評価と術後のLDCTの診断精度を比較する.
- 手術後のルーティンのLDCTを手術中の評価で置き換える可能性を評価する.
主な方法:
- 片側VADLを施した1,105人の患者を遡及的に分析し,端が柔軟な真空補助吸管尿路アクセスシート (tFVS-UAS) を使用した.
- 30日後の手術後のLDCTは基準基準として使用された.
- マクネマーのテストとカッパの統計を用いて合意を評価し,感度,特異性,PPV,NPVを計算した.
主要な成果:
- 全体的に石抜き率は83.35%でした.
- 整体SFSに対する手術内評価は高特異性 (98. 70%) が,低感度 (43. 48%) を示した.
- 合意は,20mm (カッパ=0.61) 以上の石 (カッパ=0.40) よりも強かった.
結論:
- 低リスクの患者にLDCTの使用を減らす可能性を示唆します.
- LDCTは,内視検査の感度が限られているため,20ミリメートル以上の石や高リスクのシナリオに不可欠です.
- 臨床的実施には リスクの階層化と 患者のケアを最適化するための 共有された意思決定が必要です
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