邢滇霞　黄培　赵冬青　满建仁　付建军　马怿民　尚拥军　杜凡

摘要：目的 探討碎石术前能谱CT在体所测结石成分与碎石难易程度的关系。方法 体外震波碎石治疗的泌尿系结石患者在术前进行能谱CT扫描，测量有效原子序数在体分析其结石成分，最后根据碎石次数比较各组结石碎石难易程度。结果 不同成分的结石其碎石难易程度差异有统计学意义（P<0.05）。一水草酸钙结石与磷酸镁铵结石、一水草酸钙结石与磷酸钙结石、一水草酸钙结石与胱氨酸结石、一水草酸钙结石与尿酸结石、二水草酸钙结石与磷酸镁铵结石、二水草酸钙结石与胱氨酸结石、二水草酸钙结石与尿酸结石、磷酸镁铵结石与磷酸钙结石、磷酸镁铵结石与胱氨酸结石、磷酸钙结石与胱氨酸结石、磷酸钙结石与尿酸结石、胱氨酸结石与尿酸结石各组间均有统计学意义（P<0.05），其余两种结石之间比较无统计学意义（P>0.05）。结论 能谱CT经有效原子序数体内所测得不同成分的结石之间碎石难易程度不同。胱氨酸结石碎石难度最大，其次一水草酸钙结石较难碎，磷酸镁铵结石碎石难度最低。

关键词：泌尿系结石；能谱CT；有效原子序数；结石成分；体外震波碎石术

Analysis of the Relationship between the Composition of Urinary Calculi and the Degree of Difficulty of Lithotripsy by CT

XING Dian-xia1，HUANG Pei1，ZHAO Dong-qing2，WAN Jian-ren2，FU Jian-jun2，MA Yi-min2，SHANG Yong-jun2，DU Fan2

（1.Shihezi University School of Medicine，Shihezi 832000，Xinjiang，China；

2.Department of Radiology，474 Hospital of People's Liberation Army，Urumqi 830000，Xinjiang，China）

Abstract：Objective To investigate the spectrum measured by CT before lithotripsy stone composition and gravel in the body of the degree of difficulty.Methods The patients with urinary calculi extracorporeal shock wave lithotripsy energy spectrum CT scan before operation， measuring the effective atomic number analysis of stone composition in body，according to the number of gravel were stone rubble difficulty.Results The different components of the gravel stones difficult to have statistical significance difference degree（P<0.05）.A water calcium oxalate stone and magnesium ammonium phosphate stones，calcium oxalate stones and calcium phosphate stones，calcium oxalate stones and cystine stones，calcium oxalate stones and uric acid stones，two water calcium oxalate stone and magnesium ammonium phosphate stones，two water calcium oxalate stone and cystine stones，two water calcium oxalate and uric acid stones，magnesium ammonium phosphate stones and calcium phosphate stones，magnesium ammonium phosphate stones and cystine stones，calcium phosphate stones and cystine stones，calcium phosphate stones and uric acid stones，meaning cystine stones and uric acid stones between groups were statistically（P<0.05），the other two a stone was not statistically significant （P>0.05）.Conclusion The energy spectrum of CT is different in the degree of lithotripsy between the stones of different compositions measured by the effective atomic number.Cystine stone crushed stone the most difficult，followed by calcium oxalate stones more difficult to break，magnesium ammonium phosphate stones gravel lowest difficulty.

Key words：Urinary calculi； energy spectrum CT；Effective atomic number；Composition of calculi；Extracorporeal shock wave lithotripsy

体外震波碎石（extracorporeal shock wave lithotripsy，ESWL），自上世纪80年代在我国已经得到广泛的应用。ESWL碎石的难易程度被认为可能与泌尿系结石的组成成分有关[1]。目前泌尿系结石成分的分析几乎均为体外方法，而由能谱CT有效原子序数（effective atomic number，Eff-Z）测量得出泌尿系结石化学成分的方法为其体内分析提供了有效的途径[2，3]，本研究拟采用这一方法预测泌尿系结石碎石的难易程度。

1 资料与方法

1.1一般资料 经解放军第474医院伦理委员会批准，收集2016年2月～7月在解放军474医院能谱CT扫描后接受体外震波碎石治疗的泌尿系结石患者共109例作為研究对象。其中男73例，女36例，年龄18～72岁，平均年龄43.1岁。发病部位：左肾结石8例，其中肾盏2例，大小2.3～2.8 mm；肾盂6例，大小2.9～15.9 mm。右肾结石6例，其中肾盏2例，大小1.7～4.0 mm；肾盂4例，大小5.8～13.6 mm。左输尿管结石51例，上段14例，大小1.3～13.6 mm；中段9例，大小3.3～11.0 mm；……