术后内镜评估可以取代术后低剂量CT以评估真空辅助除尘石的状态吗?
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
概括
在真空辅助的石灰除术后,手术内视镜评估准确地证实了无石头的状态,这可能会减少对特定患者的低剂量计算机断层扫描 (LDCT) 的需求. 然而,对于较大的石头或高风险病例来说,LDCT仍然至关重要.
科学领域:
- 泌尿外科
- 内分泌学
- 医学成像
背景情况:
- 对于治疗成功至关重要的是确定石头无损状态 (SFS).
- 低剂量计算机断层扫描 (LDCT) 是目前SFS评估的标准.
- 在手术内进行内镜评估为减少辐射暴露和成本提供了潜在的替代方案.
研究的目的:
- 在逆行真空辅助除尘术 (VADL) 后,将手术内内镜评估与术后LDCT的诊断准确度进行比较.
- 评估常规术后的LDCT是否可以用手术期间的评估来代替.
主要方法:
- 使用可灵活的真空辅助吸收尿管接入 (tFVS-UAS) 进行单侧VADL的1,105名患者的回顾性分析.
- 在手术后30天的LDCT作为参考标准.
- 用麦克纳马的测试和卡帕的统计来评估一致性; 计算了敏感性,特异性,PPV和NPV.
主要成果:
- 总体而言,没有石头的比例为83.35%.
- 整体SFS的内科评估显示高特异性 (98. 70%),但敏感性低 (43. 48%).
- 对于≤20毫米 (卡帕=0.61) 的石头,相比于>20毫米 (卡帕=0.40) 的石头,一致性更强.
结论:
- 术内内镜评估可靠地证实SFS的石头≤20毫米,这表明低风险患者可能减少LDCT的使用.
- 由于内镜评估的敏感性有限,LDCT对于大于20毫米或高风险场景至关重要.
- 临床实施需要风险分层和共享决策以优化患者护理.
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