S-ReSC和S.T.O.N.E.评分系统预测经皮肾镜取石术后结石清除率的应用比较

Comparison of S-ReSC and S.T.O.N.E.scoring systems in predicting stone clearance rate after percutaneous nephrolithotomy

目的比较S-ReSC和S.T.O.N.E.评分系统对经皮肾镜取石术后结石清除率的预测价值。方法收集2016年9月至2019年4月在本院接受F24标准通道经皮肾镜取石术治疗的113例结石患者的临床资料,根据术后结石是否清除分为结石清除组82例和结石残留组31例。根据S-ReSC和S.T.O.N.E.评分系统分别对患者进行S-ReSC和S.T.O.N.E.评分,采用受试者工作特征(ROC)曲线分析S-ReSC和S.T.O.N.E.评分系统对结石清除的预测价值,采用多因素logistic回归模型分析影响结石清除的因素。结果结石清除组手术时间、术中出血量和住院时间均低于结石残留组(t=2.325、2.726、2.301,P<0.05);结石清除组S-ReSC评分和S.T.O.N.E.总评分低于结石残留组(t=10.673、5.147,P<0.05),两组S.T.O.N.E.评分中结石最大截面积、皮肾通道距离、肾积水程度、累及肾盏个数四项评分分布比较,差异有统计学意义(χ2=9.296、4.543、4.292、8.533,P<0.05),两组结石密度评分比较,差异无统计学意义(χ2=2.105,P>0.05);S-ReSC评分、S.T.O.N.E.总评分、结石最大截面积、肾积水程度、累及肾盏个数与结石清除状态有相关性(P<0.05),而皮肾通道距离、结石密度与结石清除状态无相关性(P>0.05);S-ReSC评分、S.T.O.N.E.评分预测结石清除的ROC曲线下面积(AUC)分别为0.875(95%CI:0.796~0.953)、0.751(95%CI:0.655~0.847),S-ReSC评分预测结石清除的AUC大于S.T.O.N.E.评分(Z=2.117,P=0.034);多因素logistic回归分析显示,手术时间、S-ReSC评分和S.T.O.N.E.评分是结石清除的影响因素。结论 S-ReSC和S.T.O.N.E.评分系统均是预测经皮肾镜取石术后结石清除率的有效方法,S-ReSC评分的预测准确性更好。

Objective To compare the predictive values of S-ReSC and S.T.0.N.E.scoring systems for stone removal after percutaneous nephrolithotomy.Methods From September 2016 to April 2019,the data of 113 patients with calculi undei*went F24 standard channel percutaneous nephrolithotomy in our hospital were collected,according to whether or not the calculi were cleared after operation,they were divided inlo 82 cases in stone removal group and 31 cases in stone remnant group,according to S-KeSC and S.T.0.N.E.scoring system,the patients were scored,the predictive values of S-ReSC and S.T.0.N.E.scores for stone clearance was analyzed by using the receiver operating characteristic curve(ROC),multivariate logistic regression model was used to analyze the factors affecting stone removal.Results The operation time,intraoperative bleeding,and hospitalization time in the stone removal group were lower than those in the stone remnant group(t=2.325,2.726 and 2.301,P<0.05).The S-ReSC score and S.T.0.N.E.total score in stone removal group was lower than that in remnant group(t=10.673,5.147,P<0.05),there were significant differences in the distribution of the maximum cross-sectional area of stone(S),the skin-kidney channel distance(T),the degree of hydronephrosis(O),and the number of calyces involved(N)between the two groups(χ^2=9.296,4.543,4.292,8.533,P<0.05),there was no significant difference in stone density(E)score(χ^2=2.105,P>0.05).S-ReSC score,S.T.0.N.E.total score and maximum cross-sectional area of stone,degree of hydronephrosis and number of calyces involved were related to stone clearance status(P<0.05),but distance of skin-kidney channel and stone density were not related to stone clearance status(P>0.05).The area under the ROC curve(AUC)of S-ReSC score and S.T.0.N.E.score in predicting stone removal was 0.875(95%CI:0.796-0.953)and 0.751(95%CI:0.655-0.847),respectively,the AUC of S-ReSC score in predicting stone removal was greater than that of S.T.O.N.E.score(Z=2.117,P=0.034).Multivariate logistic regression analysis showed that operation time,SReSC score,and S.T.0.N.E.score were the influencing factors of stone removal.Conclusions S-ReSC and S.T.0.N.E.scoring systems are effective methods for predicting stone clearant^e after percutaneous nephrolithotomy,and S-ReSC scoring system has a better prediction accuracy.