目的 探讨疼痛点定位视觉模拟评分法(VAS)与影像学检查联合应用对急性肾绞痛输尿管结石的定位及诊断价值.方法 急性肾绞痛且疑诊输尿管结石的患者374例,随机分成VAS组和对照组.VAS组先应用VAS评估输尿管压痛点的疼痛评分,随后2组均应用二维和彩色多普勒超声对榆尿管的3个生理狭窄进行扫查,超声显示输尿管扩张未检出结石的需结合肾盂静脉造影及CT检查结果,评估并显示输尿管结石梗阻部位及超声诊断准确率.结果 输尿管腹段结石超声诊断准确率为100％( 102/102),输尿管盆段结石为83.5％( 66/79),输尿管壁内段结石为96.9％( 187/193).超声联合肾盂静脉造影及CT检查诊断的全部输尿管结石中,其梗阻部位VAS评分腹段为8.3±1.7,盆段为8.6±1.4,壁内段为8.9±1.1,评分显著高于同组非结石梗阻部位(P＜0.05).VAS组与对照组比较,梗阻部位输尿管结石的检出率显著提高(P＜0.05).结论 疼痛点定位VAS与影像学检查联合应用,对诊断输尿管结石梗阻部位具有重要指导作用,有助于提高超声定位及结石检出率.%Objective To investigate the value of joint application of visual analogue scale (VAS) of pain point positioning and imaging in acute renal colic in the positional diagnosis of ureteral calculi. Methods VAS method of pain point positioning was used to evaluate the pain of ureter tender spots on 374 acute renal colic patients with suspended ureteral calculi from emergency department. Then two dimension and color Doppler ultrasound were used to scan on three physiological ureteral strictures and structures around to find the obstructive locality, and IVP and CT were used to confirm the calculi position which were not shown by ultrasound. Results Diagnosis accuracy by ultrasound was shown as follows:ureteral calculi in the section of abdominal ureter were 100% (102/102),ureteral calculi in the section of pelvis ureter were 83.5% (66/79),and ureteral calculi in the section within the bladder wall were 96.9% (187/193). The VAS of the obstructive position diagnosed by ultrasound combined with pelvic venography and CT scan were 8.3±1.7 in the section of abdominal ureter, 8.6±1.4 in the section of pelvis ureter and 8.9±1.1 in the section within the bladder wall,which were higher than that of non-constructive position (P< 0.05). The detecting rate of calculi was increased significantly by method of VAS than that of control group (P < 0.05). Conclusion The joint application of visual analogue scale of pain point positioning and imaging was helpful in detecting the position of calculi construction,and improving the detecting rate of calculi position.
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