改良Guy’s肾结石分级法在预测经皮肾镜取石术后清石率中的应用研究

Efficacy of modified Guy＇s stone score system in predicting stone-free rate after PCNL ]

目的对Guy’s肾结石分级法进行改良并研究应用该分级法预测PCNL术后一期清石率的有效性。方法回顾性分析2010年6月至2011年4月收治的145例肾结石患者的临床资料。男92例，女53例。年龄16～72岁，平均38岁。结石长径15～48mm，平均32mm。结石负荷2．1～57．0 ml，平均35．0ml。根据患者术前CT、KUB、IVU、B超等影像资料，应用改良Guy’S肾结石分级法进行分级。改良Guy’S肾结石分级法分为4级：G1为。肾盂和中、下盏的单发结石；G2为上盏单发结石并且集合系统解剖正常、多发结石（≥2个肾盏）并且集合系统解剖正常、单发结石并且集合系统解剖异常；G3为多发结石（≥2个肾盏）并且集合系统解剖异常、肾盏憩室和部分鹿角形结石；G4为完全鹿角形结石、脊柱畸形（脊柱侧凸、前凸、脊柱裂等）、肾脏发育异常（重复。肾、马蹄肾等）、脊柱损伤。本组患者均由同一名医生完成PCNL手术。应用统计学分析改良Guy’s。肾结石分级与SFR的相关性。结果本组改良Guy’s肾结石分级G122例（15．2％），G227例（18．6％），G336例（24．8％），G460例（41．4％）。清石率分别为G1100．0％（22／22），G292．6％（25／27），G386．1％（31／36），G481．7％（49／60），各组间比较差异有统计学意义（P〈0．05），改良Guy’s肾结石分级与PCNL术后清石率呈相关性（P〈0．05）。结论改良Guy’s肾结石分级法可以有效预测PCNL术后清石率。

Objective To modify the Guy＇s stone score system and evaluate the validation of the modified score system in grading the complexity of percutaneous nephrolithotomy （PCNL） and predicting the stone-free rate after PCNL. Methods The modified system comprises 4 grades： grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones （ located in 2 or more 2 calyces） in a patient with simple anatomy or a solitary stone in a pa- tient with abnormal anatomy; grade III, multiple stones in patients with abnormal anatomy or stones in a cal- iceal diverticulum or partial staghorn calculus ; grade IV, staghorn calculus or any stone in a patient with spi- nal injury or spine malformation （ e. g. spina bifida, scoliosis, lordosis） ; kidney dysplasia （ e. g. duplex kidney, horseshoe kidney）. It was validated on a database of 145 PCNL procedures performed by a single surgeon in a stone center. The clinical outcomes were retrospectively assessed with multivariate analysis. Results Of the 145 PCNL patients, according to Guy＇s stone score system and the modified score system, there were 22 G1 cases （15.2%） and 22 SFR cases （100.0%） ; 27 G2 cases （18.6%） and 25 SFR cases （92.6%）; 36 G3 cases （24.8%） and SFR（31, 86.1% ）; 60 G4 eases （41.4%） and 49 SFR cases （81.7%）. Showing that the modified Guy＇s stone score was more accurate in predicting stone-free rate after PCNL （ P 〈 0.05 ）. Conclusions The modified Guy＇s stone score system can accurately predict the stone-free rate after PCNL than the old system.