不同评分模式对经皮肾镜取石术后结石残留的预测价值

Predictive value of different scoring models for residual stones after percutaneous nephrolithotomy

目的对比肾结石S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分对经皮肾镜取石术(PCNL)后结石残留的预测价值。方法纳入2015年1月至2018年1月于乐山市人民医院接受PCNL的95例肾结石患者,根据术后结石是否残留划分为残留组(n=28)和清除组(n=67)。统计并对比2组患者一般资料、手术情况、S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分。采用Logistic回归分析明确各评分与结石残留的关系,采用受试者工作特征(ROC)曲线分析并对比各评分模式对结石残留的预测价值。结果清除组结石最大截面积、最大受累截面积、受累肾盏数均明显低于残留组,清除组结石分布于中下盏或肾盂者占比明显高于残留组,清除组手术时间、术中出血量、术后住院时间均明显少于残留组,上述差异均有统计学意义(P<0.05)。清除组S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分均明显低于残留组,差异有统计学意义(P<0.05)。Logistic回归分析显示,S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分均与术后结石残留明显相关(P<0.05)。ROC曲线显示S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分均能够有效预测术后结石残留,曲线下面积分别为0.803、0.889、0.871,SHA.LIN及S-ReSC评分的ROC曲线下面积明显大于S.T.O.N.E.评分(P<0.05)。结论S.T.O.N.E.评分、SHA.LIN评分、S-ReSC评分均能够预测PCNL术后结石残留清除情况,且SHA.LIN评分、S-ReSC评分的预测价值优于S.T.O.N.E.评分。

Objective To compare the predictive value of S.T.O.N.E.score,SHA.LIN score and S-ReSC score for residual calculi after percutaneous nephrolithotomy(PCNL).Methods A total of 95 patients with renal calculi who received PCNL during Jan.2015 and Jan.2018 were divided into the stone-residual group(n=28)and stone-free group(n=67)according to post-PCNL stone status.The general data,operation outcomes,S.T.O.N.E.score,SHA.LIN score and S-ReSC score were compared between the two groups.The relationship between the three scoring systems and stone staus was determined with Logistic regression analysis.The predictive value of the three scoring systems for residual stones was analyzed with receiver operating characteristic(ROC)curve.Results The stone-free group had significantly smaller maximum cross-sectional area of stones,smaller maximum involved area,fewer number of affected renal calyx,less amount of intraoperative blood loss,shorter postoperative hospital stay,and higher proportion of inferior calyx or renal pelvis stones than the stone-residual group(all P<0.05).The stone-free group had significantly lower S.T.O.N.E.score,SHA.LIN score and S-ReSC score than the stone-residual group(P<0.05).Logistic regression analysis showed that S.T.O.N.E.score,SHA.LIN score and SReSC score were significantly correlated with post-PCNL stone status(P<0.05).The ROC curve showed that the S.T.O.N.E.score,SHA.LIN score and S-ReSC score were effective in predicting residual stones after PCNL,and the area under the curve was 0.803,0.889,and 0.871,respectively.The area under ROC of SHA.LIN and S-ReSC scores were significantly greater than that of S.T.O.N.E.score(P<0.05).Conclusion S.T.O.N.E.,SHA.LIN and S-ReSC scoring system can effectively predict the stone-free rate after PCNL,and the predictive value of SHA.LIN score and S-ReSC score are better than that of S.T.O.N.E.score.