改良RUSS肾结石评分预测输尿管软镜术后结石清除率的可行性  

Feasibility study of modified RUSS to predict the stone free rate after flexible ureteroscopic lithotripsy

作　　者：李武学[1] 许长宝[1] 赵兴华[1] 郝斌[1] 王友志[1] 樊军芳[1] 潘东升[1] Li Wuxue;Xu Changbao;Zhao Xinghua;Hao Bin;Wang Youzhi;Fan Junfang;Pan Dongsheng(Department of Urology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450014

出　　处：《中华泌尿外科杂志》2019年第11期843-848,共6页Chinese Journal of Urology

摘　　要：目的探讨改良Resorlu-Unsal肾结石评分(RUSS)系统预测输尿管软镜术后肾结石清除率的可行性。方法回顾性分析2017年3月至2019年1月郑州大学第二附属医院行输尿管软镜碎石术(FURL)治疗的104例肾结石患者的临床资料,男75例,女29例。年龄20~75岁,平均(47.8±13.2)岁。体质指数18.2~38.3 kg/m^2,平均(24.4±3.7)kg/m2。肾结石位于左侧56例,右侧48例。非肾下盏结石81例;肾下盏结石23例,其中19例肾盂肾下盏漏斗夹角(IPA)<45°。美国麻醉医师协会(ASA)评分:Ⅰ级65例,Ⅱ级39例。术前伴尿路感染71例;术前行肾穿刺造瘘6例;术前留置输尿管支架管26例;有术侧体外冲击波碎石治疗史32例,有排石药物治疗史27例。由同一名医师利用患者术前泌尿系CT+3D重建检查结果,分别采用RUSS和改良RUSS对患者术前结石情况进行评分。改良RUSS标准:①结石直径>20 mm(每增加10 mm再增加1分);②结石位于肾下盏且IPA<45°;③结石多发且位于不同的肾盏(含鹿角形结石);④肾解剖位置异常(异位肾、马蹄肾、重复肾、肾盏憩室、肾脏旋转不良);⑤结石平均CT值>950 HU;⑥结石面积>200 mm2。每项计1分。104例均由同一术者在全麻下行电子输尿管软镜联合钬激光碎石术。分析改良RUSS与结石清除情况的关系。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),比较改良RUSS与RUSS,以及结石特征预测结石清除率的差异。结果本研究104例术后4周的结石清除率为69.2%(72/104),均无术后并发症。RUSS 0~3分的清除率分别为86.8%(33/38)、67.7%(23/34)、58.3%(14/24)和25.0%(2/8),结石评分均与清除率显著相关(P<0.05);清石组与残石组总评分分别为(0.87±0.96)分和(1.53±0.98)分,差异有统计学意义(P<0.05)。改良RUSS 0~4分的清除率分别为100.0%(25/25)、92.3%(24/26)、54.2%(13/24)、47.4%(9/19)、10.0%(1/10),结石评分均与清除率显著相关(P<0.05);清石组与残石组总评分分别为(1.15±1.13)�Objective To explore the feasibility of the modified RUSS(Resorlu-Unsal Stone Score)renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL).Methods Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university,including 75 males and 29 females.Age 20-75(47.79±13.21)years.BMI 18.2-38.3(24.4±3.7)kg/m^2;Crushed stone site:left 56 cases,right 48 cases.There were 23 cases of renal inferior calyces calculi,81 cases of non-inferior calyces calculi,and 19 cases of renal inferior calyces calculi with IPA<45°;American Society of Anesthesiology(ASA)scores:65 cases of gradeⅠ,39 cases of gradeⅡ;There were 71 patients with urinary tract infection before operation.There were 6 cases of renal puncture fistula before operation.Preoperative indwelling ureteral stent in 26 cases;There were 32 cases with history of extracorporeal shock wave lithotripsy.There were 27 patients with a history of urolithiasis therapy.The same physician used preoperative urinary CT+3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate.RUSS renal stone scoring system was used to score the stones of patients before operation,and the relationship between the scores and the stones free rate was analyzed.The RUSS renal stone scoring system was supplemented and improved by including staghorn stone,duplicate renal,caliceal diverticulum,renal malrotation,stone area,and CT value related indexes.The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients,and the relationship between the score and the stone free rate was analyzed.The receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)was calculated to compare the advantages and disadvantages of the modified RUSS,the characteristics of the stones,and RUSS system.Results The stone free rate was 69.2%(72/104)4 weeks after th

关 键 词：输尿管镜 肾结石评分系统 输尿管软镜 清除率 影响因素 

分 类 号：R69[医药卫生—泌尿科学]