SHA.LIN评分和S.T.O.N.E评分对经皮肾镜取石术结石清除率的预测价值比较

Comparison of the Predictive Value of SHA.LIN Scores and S.T.O.N.E Scores on the Stone Removal Rate of Percutaneous Nephrolithotomy

目的:比较SHA.LIN评分和S.T.O.N.E评分对经皮肾镜取石术结石清除率的预测价值。方法:选择我院于2016年1月-2017年12月期间行经皮肾镜取石术患者67例为研究对象,在术前对所有患者进行SHA.LIN评分和S.T.O.N.E评分。根据手术结果将患者分为结石清除组(n=49)和结石残留组(n=18),对两组患者的一般资料、SHA.LIN评分、S.T.O.N.E评分进行统计对比。采用多因素Logistic回归分析方法分析患者术后结石残留的影响因素。采用绘制ROC曲线的方法分析SHA.LIN评分和S.T.O.N.E评分对结石清除率的预测结果的敏感性和特异性。结果:67例患者术后结石清除者49例、结石残留者18例,结石清除率为73.13%。结石残留组患者手术时间、术中失血量、住院时间、结石最大截面积、最大累积截面积、结石解剖分布肾盂的发生率、受累肾盏数均高于结石清除组,穿刺通道长度低于结石清除组(P<0.05)。结石清除组患者的SHA.LIN评分、S.T.O.N.E评分均低于结石残留组(P<0.05)。经多因素Logistic回归分析显示,手术时间、术中失血量、SHA.LIN评分、S.T.O.N.E评分、受累肾盏数是结石残留的影响因素(P<0.05)。通过绘制ROC曲线可知,SHA.LIN评分的敏感性为91.25%、特异性为89.12%、曲线下面积(AUC)为0.912(95%CI 0.869~0.948);S.T.O.N.E评分的敏感性为78.75%、特异性为84.24%、AUC为0.782(95%CI 0.690~0.871)。结论:经皮肾镜取石术患者结石清除率与SHA.LIN评分、S.T.O.N.E评分明显相关,两种评分系统均能预测患者的结石清除率,但SHA.LIN评分的敏感性、特异性高于S.T.O.N.E评分。

Objective： To observe and compare the predictive value of SHA.LIN and S.T.O.N.E scores on the stone removal rate of percutaneous nephrolithotomy. Methods： 67 cases of percutaneous neurolithotomy who were treated in our hospital from January 2016 to December 2017 were selected as the research subjects, and all the patients were scored by SHA.LIN scores and S.T.O.N.E scores before operative. The patients were divided into stone clearance group（n=49） and stone residual group（n=18） according to the surgical results. The general data, SHA.LIN scores and S.T.O.N.E scores of two groups of patients were statistically compared. The influencing factors of postoperative residual stones in patients was analyzed by Multiple factor regression analysis of Logistic. The ROC curve was used to compare the sensitivity and specificity of SHA.LIN scores and S.T.O.N.E scores to the prediction of stone clearance. Results：There were 49 cases of stone clearance and 18 cases of stone residual in 67 patients, and the stone clearance rate was 73.13%. The operation time, blood loss, hospitalization time, the largest stone cross-sectional area, the maximum cumulative cross-sectional area, the incidence of renal pelvis calculi anatomic distribution, involvement of renal calices in the stone residual group were higher than that of the stone clearance group, puncture channel length was less than that of the stone clearance group（P0.05）. The SHA.LIN scores and S.T.O.N.E scores of the patients in the stone clearance group were lower than those of the stone residual group（P0.05）. Multiple factor regression analysis of Logistic showed that operation time, blood loss, SHA.LIN scores, S.T.O.N.E scores and affected renal calyx number were the influencing factors of residual stone（P0.05）. By drawing the ROC curve, the sensitivity of the SHA.LIN scores was91.25%, the specificity was 89.12%, and the area under the curve（AUC） was 0.912（95% CI 0.869~0.948）. The sensitivity of S.T.O.N.E scores was 78.75%, the specificity was 84.24%, and AUC were 0.782（95%CI 0.690~0.871）. Conclusion： Percutaneous nephrolithotomy is obviously related to stone clearance rate, SHA.LIN scores and S.T.O.N.E scores, two scoring systems can predict with the stone clearance rate,but the sensitivity and specificity of SHA.LIN scores is higher than that of S.T.O.N.E scores.