S.T.O.N.E.肾结石评分系统用于经皮肾镜取石术的临床研究

Clinical study of the application of S.T.O.N.E.nephrolithometry scoring system for the percutaneous nephrolithotomy

目的 探讨S.T.O.N.E.肾结石评分系统用于经皮肾镜取石术（PCNL）的临床意义.方法 选取复旦大学附属中山医院泌尿外科2011年2月至2013年5月收治的106例施行PCNL的肾结石患者进行回顾性临床分析,收集患者的一般情况、术前情况、结石特征、手术情况及围手术期情况等,根据S.T.O.N.E.肾结石评分系统对患者术前的结石进行评分,分析S.T.O.N.E.评分与结石清除状态、估计失血量、住院天数、术后并发症等临床数据的关系. 结果 本组106例S.T.O.N.E.评分为（7.65±1.37）分,结石清除率为79.2％ （84/106）,32例（30.2％）出现术后并发症.结石清除组的S.T.O.N.E.评分为（7.37±1.22）分,残留组为（8.73±1.38）分,组间比较差异有统计学意义（t=-4.517,P=0.000）.S.T.O.N.E.评分与术后结石清除状态相关（P＜0.01）,但与术后并发症、估计失血量及住院天数均不相关（P＞0.05）. 结论 S.T.O.N.E.肾结石评分系统能预测PCNL的术后结石清除状态,具有完善病情评估的作用,但仍须进一步研究以证实其预测围手术期情况及术后并发症的能力.

Objective To investigate the clinical value of S.T.O.N.E.nephrolithometry scoring system for nephrolithiasis in patients undergoing percutaneous nephrolithotomy （PCNL）.Methods A retrospective analysis was conducted of clinical data of 106 patients with nephrolithiasis undergoing PCNL from February 2011 to May 2013 in our hospital.The general conditions,preoperative information,stone characteristics,operation approaches and perioperative variables were collected.The correlation of nephrolithometry scores based on S.T.O.N.E.scoring system with stone-free status,estimated blood loss,length of hospital stay and postoperative complications were analyzed.Results The S.T.O.N.E.score was 7.65±1.37 in this study.The stone-free rate was 79.2％ （84/106）.Postoperative complications occurred in 32 cases （30.2％）.In those patients with stone-free,the S.T.O.N.E.score was 7.37± 1.22,significantly lower than that in those patients with residual stones （8.73 ± 1.38） （t =-4.517,P =0.000）.The S.T.O.N.E.score showed significant correlationship with the postoperative stone-free status （P＜0.01）.But,it did not correlate with postoperative complications,estimated blood loss or length of hospital stay （P＞0.05）.Conclusions The S.T.O.N.E.nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting perioperative variables and postoperative complications.