逆行肾内手术治疗肾下盏结石的新评分系统

Establishment of a new scoring system for the treatment of lower calyceal calculus by retrograde intrarenal surgery

目的:定义针对逆行肾内手术治疗肾下盏结石清石率(stone-free rate, SFR)的新评分系统,同时探讨其预测价值,并与其他评分系统进行比较。方法:以泌尿系CT平扫为依据来测量肾下盏解剖结构和肾下盏结石特征参数,采用上述数据建立排石难度评分系统。回顾性分析2021年9月—2023年2月武汉大学人民医院收治的82例因单纯肾下盏结石行逆行肾内手术治疗的患者临床资料。根据患者术后复查的影像学结果,将患者分为高SFR组与低SFR组。使用统计学方法分析各因素与SFR的关系。分别计算新定义的排石难度评分系统及其他评分系统得分,并用受试者工作特征曲线(ROC)下的面积将排石难度评分系统与另外3种结石评分系统进行对比。结果:排石难度评分系统成功建立,按照选取的结石参数特征的不同分别记为排石难度MAX评分和排石难度AVE评分。本研究82例,高SFR组49例(59.76%),低SFR组33例(40.24%)。2组患者一般资料差异无统计学意义,在结石最大CT值(P<0.001)、结石平均CT值(P=0.034)以及结石体积(P=0.029)上的差异均有统计学意义。与术后SFR显著相关的评分系统ROC曲线下面积分别为0.68(排石难度MAX评分)、0.675(排石难度AVE评分)、0.672(ln排石难度MAX评分)、0.676(ln排石难度AVE评分)、0.643(R.I.R.S.评分)和0.623(T.O.HO.评分)。结论:对于肾下盏结石,排石难度评分系统能更好地预测逆行肾内手术的SFR,其中排石难度MAX评分预测效果最好。

Objective:To define a new scoring system for the stone-free rate(SFR)of lower calyceal calculus treated by retrograde intrarenal surgery(RIRS),to explore its predictive value,and to compare it with other scoring systems.Methods:The anatomy of the renal calyces and the characteristic parameters of the lower calyceal calculus were measured by non-contrast urological CT scanning,and the stone removal difficulty scoring system was established by using the above data.A retrospective analysis was performed for the clinical data of 82 patients admitted to Renmin Hospital of Wuhan University who underwent RIRS for subrenal calculi from September 2021 to February 2023.According to the plain film of kidney-ureter-bladder(KUB)results of the postoperative review,the patients were divided into high SFR group and low SFR group.The relationship between each factor and the SFR was clarified by statistical analysis method.The scores of the newly defined stone removal difficulty scoring system and other commonly used scoring systems were calculated separately,and the area under curve(AUC)of the receiver operating characteristic curve(ROC)was used to compare the stone removal difficulty scoring system with the other stone scoring systems.Results:The stone removal difficulty scoring system was successfully established,and the stone removal difficulty MAX score and the stone removal difficulty AVE score were recorded according to the different characteristics of the selected stone parameters.In this study,according to the results of postoperative KUB,49 cases(59.76%)were in the high SFR group and 33 cases(40.24%)in the low SFR group.There was no difference in general data between the two groups,but the differences in the maximum CT value of stones(P<0.001),mean CT value of stones(P=0.034)and stone volume(P=0.029)were statistically significant.The AUC was O.68(Stone Removal Difficulty MAX score),0.675(Stone Removal Difficulty AVE score),0.672(ln Stone Removal Difficulty MAX score),0.676(ln Stone Removal Difficulty AVE score),0.643(R.I.R.S.score)and 0.623(T.O.HO.score).Conclusion:Compared with other scoring systems,the stone removal difficulty scoring system defined by us can better predict the SFR of RIRS,and the Score of Stone Removal Difficulty MAX has the bestpredictioneffect.