Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
1
admin
1683-1764
1735-7322
10.18869/acadpub.tumj
000
000
000
fa
jalali
1391
3
1
gregorian
2012
6
1
70
3
online
1
fulltext
fa
بررسی رابطه برخی مشخصات سنگ در CT اسکن با میزان موفقیت سنگشکن در درمان بیماران مبتلا به سنگ کلیه
Association between some CT characteristics of renal stones and extracorporeal shockwave lithotripsy success rate
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<p class="MsoNormal" dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify"><strong><span style="font-size: 10pt">زمینه و هدف:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 7pt">CT</span><span style="font-size: 10pt"> <span lang="FA">اسکن اسپیرال بدون کنتراست در بسیاری از بیماران قبل از انجام سنگشکن </span></span><span style="font-size: 7pt">(ESWL)</span><span style="font-size: 10pt"> <span lang="FA">انجام میشود، در این مطالعه سعی میشود تا ارتباط یافتههای </span></span><span style="font-size: 7pt">CT</span><span style="font-size: 10pt"> با موفقیت سنگشکن تعیین گردد.</span><span style="font-size: 9pt"> </span></p>
<p class="MsoNormal" dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify"><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">مطالعه گذشتهنگر روی 100 بیمار با سنگ کلیه واحد با قطر </span><span style="font-size: 8pt">cm</span><span style="font-size: 10pt">5/0 تا </span><span style="font-size: 8pt">cm</span><span style="font-size: 10pt">5/2 که برای اولینبار تحت سنگشکن قرار گرفتند، انجام شد. </span><span style="font-size: 7pt">CT</span><span style="font-size: 10pt"> <span lang="FA">قبل از درمان از لحاظ دانسیته، فاصله از پوست، محل و سایز سنگ<strong> </strong>بررسی گردید. موفقیت سنگشکن بر اساس </span></span><span style="font-size: 7pt">KUB</span><span style="font-size: 10pt"> دو هفته بعد از آن بهصورت بدون سنگ، قطعات </span><span style="font-size: 8pt"><</span><span style="font-size: 8pt">mm</span><span style="font-size: 10pt">5 (هر دو موفق)، قطعات </span><span style="font-size: 8pt">></span><span style="font-size: 8pt">mm</span><span style="font-size: 10pt">5 و بدون تغییر (هر دو ناموفق) تعریف گردید.<strong> </strong></span></p>
<p class="MsoNormal" dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify"><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">از 100 مورد، 32 زن و 68 مرد با</span><span lang="AR-SA" style="font-size: 10pt"> </span><span style="font-size: 10pt">میانگین سنی 7/46 سال بودند. 55 مورد </span><span style="font-size: 10pt">سنگشکن موفق و 45 مورد ناموفق ثبت گردید. جنس (301/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)، سن (895/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) و میانگین فاصله سنگ از پوست (06/4</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) با موفقیت سنگشکن رابطهای نداشت. حجم سنگ با موفقیت سنگشکن رابطه داشت (01/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">). میانگین دانسیته در گروه سنگشکن موفق و ناموفق بهترتیب </span><sup><span style="font-size: 8pt">HU</span></sup><span style="font-size: 10pt">7/545 و </span><sup><span style="font-size: 8pt">HU</span></sup><span style="font-size: 10pt">3/962 و دانسیته با 01/0</span><span style="font-size: 7pt">P<</span><span style="font-size: 10pt"> با موفقیت سنگشکن مرتبط بود. احتمال عدم موفقیت سنگشکن در سنگهای با دانسیته بالاتر از </span><sup><span style="font-size: 8pt">HU</span></sup><span style="font-size: 10pt">740، پنج برابر سنگهای با دانسیته کمتر است.</span><strong><em><span style="font-size: 10pt"> </span></em></strong></p>
<p class="MsoNormal" dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify"><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">اندازهگیری دانسیته سنگهای ادراری در </span><span style="font-size: 7pt">CT</span><span style="font-size: 10pt"> در حالت </span><span style="font-size: 8pt">Bone window</span><span style="font-size: 10pt"> <span lang="FA">توصیه میشود و پیشنهاد میگردد که برای درمان سنگهای ادراری با دانسیته بیشتر از </span></span><sup><span style="font-size: 8pt">HU</span></sup><span style="font-size: 10pt">740 در </span><span style="font-size: 7pt">CT</span><span style="font-size: 10pt">، از روشهای درمانی جایگزین غیر از سنگشکن استفاده شود.</span></p>
<p style="text-align: justify"><strong>Background</strong>: Since non-contrast spiral CT (NCCT) is an imaging method of choice performed before extracorporeal shockwave lithotripsy (ESWL), we aimed to find the association between renal stone characteristics including stone density, location, volume, and skin-to-stone distance (SSD) on NCCT and ESWL success for a more efficient selection of patients for the procedure.</p>
<p style="text-align: justify"><strong>Methods</strong>: We retrospectively studied 100 patients having undergone initial ESWL for a solitary renal calculus of 0.5-2.5 cm. Stone size, location, density, and SSD were determined on pretreatment NNCT. The outcome was categorized as stone free, complete fragmentation (<5 mm), incomplete fragmentation (>5 mm) and unchanged, based on KUB radiography 2 weeks after ESWL.</p>
<p style="text-align: justify"><strong>Results</strong>: Of 100 patients, 32 were female and 68 were male with a mean age of 46.7 years. ESWL was successful in 55 and failure occurred in 45 patients. Sex (P=0.301), age (P=0.895) and SSD (P=4.06) were not associated with treatment success. Mean stone volume in ESWL success and failure groups, respectively were 531.4 and 930.5 mm3 and stone volume was statistically associated with treatment success (P=0.01). Mean stone density in ESWL success and failure groups were 545.7 and 962.3 HU, respectively and stone density was also associated with ESWL success (P<0.01). ESWL failure likelihood was 5 times greater in stones with a density >740 HU than smaller stones.</p>
<p style="text-align: justify"><strong>Conclusion</strong>: We strongly suggest performing densitometry in bone window for renal stones on pre-ESWL NCCT scanning and using an alternative treatment other than ESWL for stone densities greater than 740 HU.</p>
دانسیته سنگ کلیه,CT,ESWL,فاصله سنگ از پوست
CT,ESWL,renal stone density,SSD
169
175
http://tumj.tums.ac.ir/browse.php?a_code=A-10-3646-1&slc_lang=fa&sid=1
Saedi
Daryoosh
داریوش
ساعدی