S.T.O.N.E肾结石评分系统预测经皮肾镜取石术后结石残留的临床研究及改良

Validation and modification of S.T.O.N.E nephrolithometry scoring system for predicting percutaneous nephrolithotomy outcomes in Chinese patients

目的：研究S.T.O.N.E肾结石评分系统预测经皮肾镜取石术后结石残留的有效性并进行改良。方法：回顾性分析2014年1～12月收治的119例因肾结石行经皮肾镜取石术患者的临床资料,并根据患者术前CT进行S.T.O.N.E评分,分析S.T.O.N.E评分与结石残留、手术时间、术中估计失血量等临床数据的关系并进行改良。结果：结石残留患者与无结石残留患者S.T.O.N.E肾结石评分分别为（8.78±1.34）和（7.25±1.30）分（P=0.000）,119例患者S.T.O.N.E肾结石评分分布于5～11分,5～11分患者结石残留率分别为0、6.3%（1例）、30%（9例）、53.6%（15例）、63.6%（14例）、80%（8例）、88.9%（8例）。线性回归模型检验S.T.O.N.E总分与手术时间（P=0.000）、估计失血量（P=0.007）均明显相关,多因素Logistic回归分析S.T.O.N.E总分（P=0.00,OR：2.38,95%CI：1.67～3.40）与结石残留明显相关。多因素Logistic回归分析T评分、O评分与结石残留无明显相关,而S评分（P=0.02,OR：2.13,95%CI：1.13～4.03）、N评分（P=0.00,OR：4.00,95%CI：1.97～8.12）、E评分（P=0.01,OR：5.11,95%CI：1.63～16.10）与结石残留明显相关。删除与结石残留无明显相关的T、O评分,改良后总分称为S.N.E肾结石评分,线性回归模型检验S.N.E评分与手术时间（P=0.000）、估计失血量（P=0.002）明显相关,多因素Logistic回归分析S.N.E肾结石评分与结石残留明显相关（P=0.000,OR：2.683,95%CI：1.803～3.993）,S.N.E与S.T.O.N.E肾结石评分预测结石残留AUC值分别为0.794（SE：0.0421,95%CI：0.710～0.863）和0.789（SE：0.0425,95%CI：0.704～0.858）,P=0.825。结论：S.T.O.N.E肾结石评分及简化改良的S.N.E评分可有效预测PCNL术后结石残留状态,适于临床及科研应用。

Objective：To validate and modify S.T.O.N.E nephrolithometry scoring system for predicting percutaneous nephrolithotomy（PCNL）outcomes in Chinese patients.Method：A retrospective analysis of clinical data of 119 consecutive patients with nephrolithiasis who underwent PCNL from January 2014 to December 2014 was conducted.All the stones were scored according to S.T.O.N.E nephrolithometry scoring system based on preoperative CT findings.The correlation of S.T.O.N.E score and stone-residual status（SRS）,operative time（OT）and estimated blood loss（EBL）were analyzed.S.T.O.N.E nephrolithometry scoring system was modified based on the primary outcomes.Result：Mean S.T.O.N.E score（SS）of patients who had residual stones and who were stone-free were 8.78±1.34 and 7.25±1.30,respectively（P =0.000）.The SS of the 119 patients ranged from5 to 11,and stone-residual rate were 0%,6.3%,30%,53.6%,63.6%,80% and 88.9 % respectively.S.T.O.N.E score was associated with OT（P =0.000）and EBL（P =0.007）in linear regression analysis.In multivariable logistic regression analysis,S.T.O.N.E score was significantly associated with SRS（P =0.00,OR：2.38,95%CI：1.67-3.40）.The S.N.E score was significantly associated with SRS（P =0.02,P =0.00,P =0.01,respectively）but the T,O score were not significantly associated with SRS.S.T.O.N.E nephrolithometryscoring system without T,O score was called S.N.E nephrolithometry scoring system.The S.N.E score was significantly correlate with OT and EBL（P =0.000,P =0.002respectively）in linear regression analysis.Multivariable logistic regression revealed that the S.N.E score was significantly associated with SRS（P =0.000,OR：2.683,95%CI：1.803-3.993）.There was no significant difference in the areas under the curves for S.N.E nephrolithometry scoring system and the S.T.O.N.E nephrolithometry scoring system [0.794（SE：0.0421,95%CI：0.710-0.863）vs 0.789（SE：0.0425,95%CI：0.704-0.858）;P =0.825].Conclusion：The S.T.O.N.E and the S.N.E nephrolithometry scoring system accurately predict SRS after PCNL,and are suitable for clinical application and research.