SHA.LIN评分在预测输尿管镜碎石术结石清除率中的价值

SHA.LIN score for predicting the stone-free rate of patients with ureteral calculi undergoing ureteroscopic lithotripsy

目的探讨SHA.LIN评分用于预测输尿管镜碎石术后结石清除率的临床意义。方法回顾性分析南京医科大学附属明基医院泌尿外科2016年10月—2019年6月收治的388例行输尿管镜碎石取石术(URL)患者的临床资料。术前行泌尿系CT平扫+三维重建获得结石参数,由同一名泌尿外科医师采用SHA.LIN和S.T.O.N.E评分对患者术前结石特征进行评分并录入数据。根据术后1个月泌尿系CT结果将患者分为结石清除组和结石残留组,并比较两组的临床资料。分析SHA.LIN、S.T.O.N.E评分与结石清除情况、手术时间、住院时间等临床数据的关系。绘制受试者工作特征(ROC)曲线,检测SHA.LIN评分预测结石清除状态的敏感性和特异性。结果SHA.LIN评分、结石最大累计直径、肾积水程度、结石解剖分布及结石距肾盂出口的距离与结石清除状态相关,差异有统计学意义(P<0.05)。SHA.LIN评分与手术时间、术后住院时间相关,差异有统计学意义(P<0.05)。SHA.LIN评分的ROC曲线下面积(AUC)为0.878。SHA.LIN与S.T.O.N.E评分AUC相比,差异有统计学意义(P<0.001)。当SHA.LIN评分界值为10时,敏感度为78.72%,特异度为84.46%。结论SHA.LIN评分预测URL术后结石清除率准确性较好,具有术前评估的作用。

Objective To investigate the significance of SHA.LIN score for predicting the stone-free rate(SFR)in pa⁃tients undergoing ureteroscopic lithotripsy(URL).Methods Clinical data of 388 patients undergoing URL during Oct.2016 and Jun.2019 were retrospectively analyzed.Preoperative non-contrast CT was conducted and three-dimensional data were con⁃structed.A single observer reviewed and entered the SHA.LIN and SHA.LIN score;S.T.O.M.E score;area under ROC curve(AVC);With reference to urinary CT after URL,the patients and stone characteristics were compared between the stone-free pa⁃tients and those with residual stones.The correlation of SHA.LIN score;S.T.O.M.E score;area under ROC curve(AVC);with SFR,operation time and length of hospital stay was analyzed.Receiver operating characteristic(ROC)curve was drawn to detect the sensitivity and specificity of SHA.LIN score for predicting the SFR.Results SHA.LIN score,stone size,hydro⁃nephrosis,anatomic distribution of stones and distance from stones to pelvic outlet showed significant correlation with the SFR(P<0.05).SHA.LIN score showed significant correlation with operation time and postoperative hospital stay(P<0.05).The area under ROC curve(AUC)was 0.878.There was significant difference in the AUC between the SHA.LIN score and S.T.O.N.E score(P<0.001).When the cutoff was 10,the sensitivity of SHA.LIN score was 78.72%and specificity was 84.46%.Conclusion The SHA.LIN score is precise in predicting SFR after URL.