基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响分析

贺翔; 杨科; 陈贵恒

doi:10.11659/jjssx.01E022009

您当前的位置：

首页 >

文章列表页 >

基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响分析

临床研究 | 更新时间：2023-06-13

- 基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响分析
- Influence of psoas major muscle index measured by preoperative multi-slice spiral CT on the difficulty of retrograde flexible ureteroscopic laser lithotripsy
- 局解手术学杂志 2023年32卷第6期页码：506-510
- 作者机构：
  
  1.湖南省人民医院/湖南师范大学附属第一医院急诊外科，湖南长沙 410002
  2.湖南省人民医院/湖南师范大学附属第一医院泌尿外科，湖南长沙 410002
- 作者简介：
  
  杨科，E-mail：yk780218@163.com
- 基金信息：
  
  湖南省卫生健康委项目(C20180905);长沙市科技局项目(kq201495)
- DOI：10.11659/jjssx.01E022009
  中图分类号： R602
- 纸质出版日期：2023-06-25，
  
  收稿日期：2022-01-04，
扫描看全文
贺翔,杨科,陈贵恒.基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响分析[J].局解手术学杂志,2023,32(06):506-510.

HE Xiang,YANG Ke,CHEN Gui-heng.Influence of psoas major muscle index measured by preoperative multi-slice spiral CT on the difficulty of retrograde flexible ureteroscopic laser lithotripsy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(06):506-510.
贺翔,杨科,陈贵恒.基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响分析[J].局解手术学杂志,2023,32(06):506-510. DOI： 10.11659/jjssx.01E022009.

HE Xiang,YANG Ke,CHEN Gui-heng.Influence of psoas major muscle index measured by preoperative multi-slice spiral CT on the difficulty of retrograde flexible ureteroscopic laser lithotripsy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(06):506-510. DOI： 10.11659/jjssx.01E022009.

摘要

目的

分析基于术前多层螺旋CT测量的腰大肌指数对逆行输尿管软镜激光碎石手术难度的影响。

方法

对257例因输尿管上段结石接受逆行输尿管软镜激光碎石术的患者临床资料进行回顾性分析。采用多层螺旋CT测量L

椎骨水平的双侧腰大肌区域总面积，并与患者身高进行标准化得出腰大肌指数，记录总手术时间，使用线性回归分析研究手术时间的预测因素。

结果

腰大肌指数中位数为933.00 mm

（IQR：711.00~1 135.00 mm

），手术时间中位数为50.00 min（IQR：40.00~65.00 min）。在多因素线性回归分析中，调整混杂因素之后，腰大肌指数、结石平均密度是手术时间的独立预测因素。

结论

腰大肌指数是一个易于测量的影像学参数，是影响逆行输尿管软镜激光碎石手术难度的独立预测因素，通过术前估算手术时间，有利于提高术者和手术室日程安排的效率。

Abstract

Objective

To analyze the influence of psoas major muscle index measured by preoperative multi-slice spiral CT on the difficulty of retrograde flexible ureteroscopic laser lithotripsy.

Methods

The clinical data of 257 patients with upper ureteral calculi who underwent retrograde flexible ureteroscopic laser lithotripsy were analyzed retrospectively. Multi-slice spiral CT was used to measure the total area of bilateral psoas major muscle areas at L

vertebral level， and the psoas major muscle index was obtained by standardized with patient's height. The total operation time was recorded and the linear regression analysis was used to study the predictive factors of operation time.

Results

The median psoas major muscle index was 933.00 mm

（IQR：711.00 to 1 135.00 mm

）， and the median operation time was 50.00 minutes（IQR：40.00 to 65.00 minutes）. In multivariate linear regression analysis， the psoas major muscle index and the mean stone density were the independent predictors of operation time after adjusting for confounding factors.

Conclusion

The psoas major muscle index is an easy-to-measure imaging parameter and an independent predictor of the difficulty of retrograde flexible ureteroscopic laser lithotripsy. By estimating the operation time before operation， it is beneficial to improve the efficiency of the schedule of the operator and the operating room.

关键词

输尿管软镜激光碎石术腰大肌指数多层螺旋CT

Keywords

flexible ureteroscopelaser lithotripsypsoas major muscle indexmulti-slice spiral CT

references

ElSheemy MS，Elmarakbi AA，Hytham M，et al.Mini vs. standard percutaneous nephrolithotomy for renal stones：a comparative study［J］.Urolithiasis，2019，47（2）：207-214.doi：10.1007/s00240-018-1055-9http://dx.doi.org/10.1007/s00240-018-1055-9.

Türk C，Petřík A，Sarica K，et al.EAU guidelines on diagnosis and conservative management of urolithiasis［J］.Eur Urol，2016，69（3）：468-474.doi：10.1016/j.eururo.2015.07.040http://dx.doi.org/10.1016/j.eururo.2015.07.040.

Preminger GM，Tiselius HG，Assimos DG，et al.2007 guideline for the management of ureteral calculi［J］.J Urol，2007，178（6）：2418-2434.doi：10.1016/j.juro.2007.09.107http://dx.doi.org/10.1016/j.juro.2007.09.107.

Jackson TD，Wannares JJ，Lancaster RT，et al.Does speed matter？ The impact of operative time on outcome in laparoscopic surgery［J］.Surg Endosc，2011，25（7）：2288-2295.doi：10.1007/s00464-010-1550-8http://dx.doi.org/10.1007/s00464-010-1550-8.

Jenkins ED，Yom VH，Melman L，et al.Clinical predictors of operative complexity in laparoscopic ventral hernia repair：a prospective study［J］.Surg Endosc，2010，24（8）：1872-1877.doi：10.1007/s00464-009-0863-yhttp://dx.doi.org/10.1007/s00464-009-0863-y.

Ito H，Kawahara T，Terao H，et al.Predictive value of attenuation coefficients measured as Hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy：a single-center experience［J］.J Endourol，2012，26（9）：1125-1130.doi：10.1089/end.2012.0154http://dx.doi.org/10.1089/end.2012.0154.

Ofude M，Shima T，Yotsuyanagi S，et al.Stone attenuation values measured by average hounsfield units and stone volume as predictors of total laser energy required during ureteroscopic lithotripsy using holmium：yttrium-aluminum-garnet lasers［J］.Urology，2017，102：48-53.doi：10.1016/j.urology.2016.10.029http://dx.doi.org/10.1016/j.urology.2016.10.029.

Fleg JL，Lakatta EG.Role of muscle loss in the age-associated reduction in VO2 max［J］.J Appl Physiol （1985），1988，65（3）：1147-1151.doi：10.1152/jappl.1988.65.3.1147http://dx.doi.org/10.1152/jappl.1988.65.3.1147.

Frontera WR，Meredith CN，O'Reilly KP，et al.Strength training and determinants of VO2max in older men［J］.J Appl Physiol （1985），1990，68（1）：329-333.doi：10.1152/jappl.1990.68.1.329http://dx.doi.org/10.1152/jappl.1990.68.1.329.

Jones KI，Doleman B，Scott S，et al.Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications［J］.Colorectal Dis，2015，17（1）：O20-O26.doi：10.1111/codi.12805http://dx.doi.org/10.1111/codi.12805.

Lieffers JR，Bathe OF，Fassbender K，et al.Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery［J］.Br J Cancer，2012，107（6）：931-936.doi：10.1038/bjc.2012.350http://dx.doi.org/10.1038/bjc.2012.350.

Peng P，Hyder O，Firoozmand A，et al.Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma［J］.J Gastrointest Surg，2012，16（8）：1478-1486.doi：10.1007/s11605-012-1923-5http://dx.doi.org/10.1007/s11605-012-1923-5.

Yoshikawa T，Miyamoto M，Aoyama T，et al.Psoas muscle index at the fifth lumbar vertebra as a predictor of survival in epithelial ovarian cancers［J］.Mol Clin Oncol，2021，15（3）：177.doi：10.3892/mco.2021.2339http://dx.doi.org/10.3892/mco.2021.2339.

Lee SR，Jeon HG，Park DS，et al.Longitudinal stone diameter on coronal reconstruction of computed tomography as a predictor of ureteral stone expulsion in medical expulsive therapy［J］.Urology，2012，80（4）：784-789.doi：10.1016/j.urology.2012.06.032http://dx.doi.org/10.1016/j.urology.2012.06.032.

Degraeve A，Lejeune S，Muilwijk T，et al.When residents work less，they feel better：lessons learned from an unprecedent context of lockdown［J］.Prog Urol，2020，30（16）：1060-1066.doi：10.1016/j.purol.2020.08.005http://dx.doi.org/10.1016/j.purol.2020.08.005.

李强，王文佳，宋志强，等.输尿管软镜钬激光碎石取石术应用于>2 cm上尿路结石的临床疗效和安全性［J］.临床外科杂志，2020，28（2）：116-119.doi：10.3969/j.issn.1005-6483.2020. 02.005http://dx.doi.org/10.3969/j.issn.1005-6483.2020.02.005.

任晓磊，夏海波.泌尿系结石腔镜手术后尿源性脓毒血症发生的原因及防治［J］.中华腔镜泌尿外科杂志（电子版），2018，12（5）：356-358.doi：10.3877/cma.j.issn.1674-3253.2018.05.016http://dx.doi.org/10.3877/cma.j.issn.1674-3253.2018.05.016.

Tee YS，Cheng CT，Wu YT，et al.Predicting outcomes of abdominal surgical emergencies in the elderly population using a CT muscle gauge［J］.Aging Clin Exp Res，2021，33（9）：2479-2490.doi：10.1007/s40520-020-01769-9http://dx.doi.org/10.1007/s40520-020-01769-9.

Cruz-Jentoft AJ，Bahat G，Bauer J，et al.Sarcopenia：revised European consensus on definition and diagnosis［J］.Age Ageing，2019，48（4）：601.doi：10.1093/ageing/afz046http://dx.doi.org/10.1093/ageing/afz046.

Richards SJG，Senadeera SC，Frizelle FA.Sarcopenia，as assessed by psoas cross-sectional area，is predictive of adverse postoperative outcomes in patients undergoing colorectal cancer surgery［J］.Dis Colon Rectum，2020，63（6）：807-815.doi：10.1097/dcr.0000000 000001633http://dx.doi.org/10.1097/dcr.0000000000001633.

Herrod PJJ，Boyd-Carson H，Doleman B，et al.Quick and simple；psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection［J］.Tech Coloproctol，2019，23（2）：129-134.doi：10.1007/s10151-019-1928-0http://dx.doi.org/10.1007/s10151-019-1928-0.

Pedersen M，Cromwell J，Nau P.Sarcopenia is a predictor of surgical morbidity in inflammatory bowel disease［J］.Inflamm Bowel Dis，2017，23（10）：1867-1872.doi：10.1097/mib.0000000000001166http://dx.doi.org/10.1097/mib.0000000000001166.

Boer BC，de Graaff F，Brusse-Keizer M，et al.Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer［J］.Int J Colorectal Dis，2016，31（6）：1117-1124.doi：10.1007/s00384-016-2538-1http://dx.doi.org/10.1007/s00384-016-2538-1.

Nakanishi R，Oki E，Sasaki S，et al.Sarcopenia is an independent predictor of complications after colorectal cancer surgery［J］.Surg Today，2018，48（2）：151-157.doi：10.1007/s00595-017-1564-0http://dx.doi.org/10.1007/s00595-017-1564-0.

Reisinger KW，van Vugt JL，Tegels JJ，et al.Functional compromise reflected by sarcopenia，frailty，and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery［J］.Ann Surg，2015，261（2）：345-352.doi：10.1097/sla.0000000000 000628http://dx.doi.org/10.1097/sla.0000000000000628.

Zhang T，Cao L，Cao T，et al.Prevalence of sarcopenia and its impact on postoperative outcome in patients with crohn's disease undergoing bowel resection［J］.JPEN J Parenter Enteral Nutr，2017，41（4）：592-600.doi：10.1177/0148607115612054http://dx.doi.org/10.1177/0148607115612054.

Albakheet SS，Lee MJ，Yoon H，et al.Psoas muscle area and paraspinal muscle fat in children and young adults with or without obesity and fatty liver［J］.PloS One，2021，16（11）：e0259948.doi：10.1371/journal.pone.0259948http://dx.doi.org/10.1371/journal.pone.0259948.

Chikopela T，Heimburger D，Kaluba L，et al.Endothelial dysfunction and body mass index：is there a role for plasma peroxynitrite？［J］.Beni Suef Univ J Basic Appl Sci，2021，10（1）：4.doi：10.1186/s43088-020-00092-6http://dx.doi.org/10.1186/s43088-020-00092-6.

Ivanov AV，Valuev-Elliston VT，Ivanova ON，et al.Oxidative stress during HIV infection：mechanisms and consequences［J］.Oxid Med Cell Longev，2016：8910396.doi：10.1155/2016/8910396http://dx.doi.org/10.1155/2016/8910396.

Mizoue T，Kasai H，Kubo T，et al.Leanness，smoking，and enhanced oxidative DNA damage［J］.Cancer Epidemiol Biomarkers Prev，2006，15（3）：582-585.doi：10.1158/1055-9965.Epi-05-0658http://dx.doi.org/10.1158/1055-9965.Epi-05-0658.

Michel F，Negre T，Baboudjian M，et al.Micro-percutaneous nephrolithotomy （Microperc） for renal stones，outcomes and learning curve［J］.Prog Urol，2021，31（2）：91-98.doi：10.1016/j.purol.2020. 03.006http://dx.doi.org/10.1016/j.purol.2020.03.006.

Cho SY，Ryang SH，Lee DS.A presumptive role of lower ureteral angles in the difficulty of ureteral access sheath insertion during retrograde intrarenal surgery［J］.Int Urol Nephrol，2020，52（9）：1657-1663.doi：10.1007/s11255-020-02483-1http://dx.doi.org/10.1007/s11255-020-02483-1.

Aldoukhi AH，Black KM，Ghani KR.Emerging laser techniques for the management of stones［J］.Urol Clin North Am，2019，46（2）：193-205.doi：10.1016/j.ucl.2018.12.005http://dx.doi.org/10.1016/j.ucl.2018.12.005.

Knudsen BE.Laser fibers for Holmium：YAG lithotripsy：what is important and what is new［J］.Urol Clin North Am，2019，46（2）：185-191.doi：10.1016/j.ucl.2018.12.004http://dx.doi.org/10.1016/j.ucl.2018.12.004.

Sorokin I，Cardona-Grau DK，Rehfuss A，et al.Stone volume is best predictor of operative time required in retrograde intrarenal surgery for renal calculi：implications for surgical planning and quality improvement［J］.Urolithiasis，2016，44（6）：545-550.doi：10.1007/s00240-016-0875-8http://dx.doi.org/10.1007/s00240-016-0875-8.

Patel SR，Stanton P，Zelinski N，et al.Automated renal stone volume measurement by noncontrast computerized tomography is more reproducible than manual linear size measurement［J］.J Urol，2011，186（6）：2275-2279.doi：10.1016/j.juro.2011.07.091http://dx.doi.org/10.1016/j.juro.2011.07.091.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据