肾结石S.T.O.N.E.评分与Guy’s分级对经皮肾镜碎石术后结石残留预测价值的比较  

A comparative study on the predictive value of S.T.O.N.E. score and Guy’s score for renal stone residue after percutaneous nephroscopic lithotripsy

作　　者：王胜利[1] 孙超[1] 李博[1] WANG Shengli;SUN Chao;LI Bo(Department of Urology,the Third People’s Hospital,Benbu 233000,Anhui,China)

机构地区：[1]蚌埠市第三人民医院泌尿外科,安徽蚌埠233000

出　　处：《上海医学》2021年第10期760-765,共6页Shanghai Medical Journal

摘　　要：目的评价肾结石S.T.O.N.E.评分与Guy’s分级对经皮肾镜碎石术(percutaneous nephroscopic lithotripsy,PCNL)后结石残留的预测效能。方法选择2014年1月—2019年12月于蚌埠市第三人民医院泌尿外科行PCNL的肾结石患者114例,男72例、女42例;其中结石已清除(清除组)的患者77例,术后有结石残留(残留组)的患者37例。比较两组患者的临床特征、S.T.O.N.E.评分与Guy’s分级。采用多因素logisitic回归分析PCNL后结石残留的预测指标,绘制ROC曲线评价筛选所得指标的诊断效能,计算并比较不同指标的AUC。结果残留组的结石负荷显著大于清除组(P<0.01),肾皮质厚度显著小于清除组(P<0.05),手术时间显著长于清除组(P<0.01),术中出血量显著多于清除组(P<0.05)。残留组S.T.O.N.E.总评分为(8.65±1.32)分,显著高于清除组的(7.31±0.95)分(P<0.01)。残留组S.T.O.N.E.评分中结石最大横截面积2、3、4分,肾结石占肾盏数量2、3分患者所占比例均显著高于清除组(P值均<0.01);两组间穿刺通道长度、肾积水、结石密度各评分患者所占比例的差异均无统计学意义(P值均>0.05)。残留组Guy’s分级GⅢ、GⅣ级患者所占比例均显著高于清除组(P值均<0.01)。多因素logistic回归分析结果显示,S(结石最大横截面积)评分、N(受累肾盏数)评分、Guy’s分级、穿刺肾皮质厚度为PCNL后结石残留的独立预测指标。ROC曲线评价结果显示,S.T.O.N.E.总评分预测PCNL后结石残留的AUC为0.837(95%CI为0.756~0.900,P<0.05),Guy’s分级预测PCNL后结石残留的AUC为0.745(95%CI为0.655~0.822,P<0.05),S.T.O.N.E.总评分ROC曲线AUC显著高于Guy’s分级(Z=2.082,P=0.037)。S.T.O.N.E.总评分与Guy’s分级联合指标预测PCNL后结石残留的ROC曲线AUC为0.858(95%CI为0.780~0.916,P<0.05),有高于Guy’s分级的趋势,但差异无统计学意义(P>0.05)。结论S.T.O.N.E.评分与Guy’s分级对PCNL后结石残留均具有明确的预测价值,S.T.O.N.E.评分的�Objective To compare the predictive efficacies of S.T.O.N.E.score and Guy’s score on renal stone residue after percutaneous nephroscopic lithotripsy(PCNL).Methods A total of 114 patients(72 males and 42 females)with kidney calculi treated by PCNL between January 2014 and December 2019 in our hospital were enrolled in this study.Thiry-seven patients had postoperative residual stones and 77 patients achieved stone clearance.Clinical features,S.T.O.N.E.score and Guy’s score were compared between the residual group and clearance group.Multivariate logistic regression was used to screen predictive indexes of stone residue after PCNL.The diagnostic efficacy of the screened indexes was evaluated by the ROC curve,and the AUC of different indexes were calculated and compared.Results Compared with the clearance group,the residual group had greater stone load(P<0.01),thinner renal cortex(P<0.05),longer operation time(P<0.01),and more intraoperative blood loss(P<0.05).The total S.T.O.N.E.score of the residual group was significantly higher than that of the clearance group(8.65±1.32 vs 7.31±0.95,P<0.01).The proportions of patients with S.T.O.N.E.scores being 2,3,and 4 and involved calix scores being 2 and 3 in the residual group were significantly higher than those of the clearance group(all P<0.01).There was no significant difference in the punctured channel length,proportion of hydronephrosis or stone density between the two groups(all P>0.05).The proportion of patients with Guy’s grade GⅢand GⅣin the residual group was significantly higher than that in the clearance group(both P<0.01).Logistic regression showed that S(the largest cross-sectional area of the stone),N(the number of involved calices),Guy’s score and renal cortical thickness were independent predictors for stone residue.ROC curve showed that the AUC of S.T.O.N.E.score for stone residue prediction was 0.837(95%CI:0.756-0.900,P<0.05),and the AUC of Guy’s score was 0.745(95%CI:0.655-0.822,P<0.05).The S.T.O.N.E.score had significantly higher predic

关 键 词：肾结石 S.T.O.N.E.评分 Guy’s分级 结石残留 

分 类 号：R699.2[医药卫生—泌尿科学]