通过内镜与CT对皮肤穿神经解剖术 (PCNL) 后无结石状态的评估进行比较
F O Hartung1, K J Müller2, J Herrmann2
1Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. friedrich.hartung@umm.de.
Urolithiasis
|October 6, 2023
概括
术后低剂量计算机断层扫描 (LDCT) 建议在皮肤穿神经切除术 (PCNL) 后进行,以确认无石头状态. 仅仅由外科医生进行评估是不够的,因为虚假阴性率很高,尽管它在检测残留碎片 (RF) 中的可靠性很高.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 医疗成像医学成像
背景情况:
- 穿皮石切除术 (PCNL) 是一种常见的石切除手术.
- 在PCNL后评估残留碎片 (RF) 对患者的治疗结果至关重要.
- 低剂量计算机断层扫描 (LDCT) 经常用于术后评估,但其必要性仍在争论中.
研究的目的:
- 评估PCNL后术后LDCT的必要性.
- 为了比较外科医生在手术期间对射频的评估与术后的LDCT的准确性.
- 为了确定是否避免术后成像可以减少辐射暴露而不会影响无石头状态.
主要方法:
- 对610名患者的回顾性分析,这些患者在倾斜的位置接受了PCNL.
- 收集的数据包括患者的人口统计,石头参数,以及外科医生对RF的评估.
- 将外科医生的评估与手术后LDCT发现的射频检测结果进行比较.
主要成果:
- 外科医生的评估和RF的LDCT发现之间存在显著差异 (p < 0.0001).
- 外科医生的评估显示,RF的敏感性低 (24.05%) 和负预测值 (50%) .
- 排放时的高整体无石率 (SFR) (96.23%),但初级PCNL后的初始SFR为45.57%.
结论:
- 外科医生在手术期间对射频的评估不足以取代术后的LDCT.
- 由于外科医生评估的高虚假阴性率和低阴性预测值,应进行术后的LDCT.
- 在PCNL后进行术后成像的最佳时间需要进一步调查.
相关概念视频
01:25Urinary Tract Calculi VI: Surgical Management
8
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
8
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
38
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
38
01:27Imaging Studies III: Computed Tomography
13
DefinitionComputed Tomography (CT) of the genitourinary (GU) tract is a non-invasive imaging modality that utilizes X-rays and computer processing to generate detailed cross-sectional images of the urinary system, encompassing the kidneys, ureters, bladder, and adjacent structures such as the adrenal glands.PurposeCT scans of the GU tract serve several diagnostic and therapeutic purposes, including:Diagnosis of Urinary Tract Diseases: Detects kidney stones, tumors, cysts, and congenital...
13
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
29
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
29
01:30Urinary Tract Calculi III: Medical Management
9
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
9
01:26Endoscopic Procedures V: ERCP
311
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
311