2019 年第 3 期 第 14 卷

超声检查在肾结石诊断及治疗方案选择中与CT检查结果的比较性分析

Comparative analysis between ultrasonography and CT in diagnosis and treatment of renal calculi

作者：宁晨王松涛宋健张道新田野

英文作者：

单位：100050首都医科大学附属北京友谊医院泌尿外科（宁晨、宋健、张道新、田野）；100037武装警察部队北京总队第二医院外科（王松涛）

英文单位：

关键词：肾结石；超声检查；准确性；治疗方案

英文关键词：

• 摘要：

• 【摘要】目的    评估超声检查在肾结石诊断中的敏感度、特异度及准确性，分析对治疗方案制定的影响。方法    回顾性分析首都医科大学附属北京友谊医院2016年7—12月行超声和CT检查（15 d内）提示肾结石的206例患者临床资料。分析患者的一般资料、影像学检查结石的大小和位置。超声结果的敏感度、特异度及对结石大小判断的准确性以CT结果为标准。结果    超声检查肾结石的敏感度和特异度分别为57%和93%。超声检查的敏感度与结石的大小有关，＜5 mm组、5～10 mm组、＞10 mm组肾结石的敏感度为38%、80%、94%（r=0.301，P<0.05），而与结石的位置无关。在＜5 mm组、5～10 mm组中，超声检查测量的结石直径大于CT测量的结果［6（5，7）mm比3（2，3）mm、8（6，9）mm比7（6，8）mm］（P＜0.05），超声检查易高估0～10 mm范围内的结石大小。若没有结石或＜5 mm临床选用观察，≥5 mm的结石予外科干预（体外碎石或内镜治疗），则超声检查建议观察的病例中有31%的CT结果将推荐外科干预，而超声检查建议外科干预的病例中60%的CT结果将推荐观察。仅以超声结果为标准将有24%的患者会得到不适宜的治疗。结论    超声检查对肾结石的敏感度相对较低及对大小的判断欠准确，所以仅以超声结果作为外科干预的判断标准是不适宜的。

• 【Abstract】Objective    To assess the sensitivity, specificity and accuracy of ultrasonography in the diagnosis of renal calculi and its value in the guidance of therapeutic plan compared with computed tomography(CT). Methods    Clinical data of 206 patients with renal calculi who had ultrasonography and CT within 15 days after admission in Beijing Friendship Hospital, Capital Medical University between July and December 2016 were retrospectively analyzed. Baseline clinical data, size and location of calculi according to imaging examination were analyzed. Diagnostic sensitivity, specificity and accuracy of ultrasonography were determined using CT as the standard. Results    Sensitivity and specificity of ultrasonography in diagnosing renal calculi were 57% and 93%, respectively. Sensitivities of ultrasonography detecting stone size＜5 mm, 5-10 mm and ＞10 mm were 38%, 80% and 94%; the sensitivity was positively associated with stone size（r=0.301， P<0.05） but showed no association with location. Stone size measured by ultrasonography was significantly larger than that measured by CT when it is less than 5 mm or between 5 and 10 mm［6（5，7）mm vs 3（2，3）mm； 8（6，9）mm vs 7（6，8）mm］（P＜0.05）; ultrasonography tended to overestimate the size in 0-10 mm range. Renal calculi＜5 mm should be treated with clinical observation and the calculi≥5 mm could be selected for surgical intervention such as extracorporeal lithotripsy or endoscopic therapy; accordingly ultrasonography suggested that 31% cases have observation while CT would suggest a recommendation of surgery. In contrast, CT would recommend observation in 60% cases but ultrasonography suggested surgical treatment. About 24% patients might be mis-treated only based on ultrasonographic results. Conclusion    Due to the low sensitivity and inability to size renal calculi accurately of ultrasonography, it is not appropriate to make treatment decisions using ultrasonography alone.