肾脏解剖结构对经皮肾镜取石术后结石残留的影响  

The effects of renal anatomy on residual stones after percutaneous nephrolithotomy

作　　者：闻玉钢 李金永[1] 邢维思 满涛[1] 章志庆 王志强[1] WEN Yugang;LI Jinyong;XING Weisi;MAN Tao;ZHANG Zhiqing;WANG Zhiqiang(Department of Urology,the First People's Hospital of Yinchuan,Yinchuan 750001,China)

机构地区：[1]宁夏银川市第一人民医院泌尿外科,宁夏银川750001

出　　处：《宁夏医学杂志》2021年第11期961-964,共4页Ningxia Medical Journal

基　　金：宁夏自然科学基金资助项目(NZ17241)。

摘　　要：目的分析肾脏解剖结构对经皮肾镜取石术(PCNL)后结石残留的影响,并以此建立评分系统,评估分析其对PCNL术后结石残留的影响。方法行PCNL术的287例患者,分为结石清除组245例,残留组42例,对比2组患者一般资料、肾脏解剖结构数据、手术情况、STONE评分、SHALIN评分、S-ReSC评分。采用Logistic回归分析明确各指标与结石残留的关系,并建立评分系统,采用受试者工作特征(ROC)曲线分析并对比各评分系统对结石残留的影响。结果经过单因素分析和Logistic回归分析,只有结石最大截面积、肾盂肾盏高度(PCH)和S-ReSC评分是PCNL术后结石残留的独立影响因素(P<0.05)。以此建立SPS评分,并对比STONE评分、SHALIN评分、S-ReSC评分,ROC曲线分析显示4种评分方法均能有效预测术后结石残留,曲线下面积分别为0.919、0.778、0.803、0.864,SPS评分ROC曲线下面积显著大于STONE评分和SHALIN评分(P<0.05)。结论反映肾脏解剖结构的PCH,结石最大截面积及S-ReSC评分是PCNL术后结石残留的独立影响因素,以此建立的SPS评分能较好地预测术后结石清除情况,且预测价值优于STONE评分和SHALIN评分。Objective To analyze the effects of renal anatomy on residual stones after percutaneous nephrolithotomy(PCNL),and to establish a scoring system for predicting the residual stones after PCNL.Methods 287 patients who underwent PCNL were divided into stone removal group(n=245)and residual group(n=42).The demographic data,renal anatomic data,operation outcomes,STONE score,SHALIN score and S-ReSC score were compared between the two groups.Then logistic regression analysis was used for multivariate analysis.A scoring system was established according to the results of logistic regression analysis.Receiver operating characteristic(ROC)curve was used to analyze and compare the predictive value of each scoring mode for residual stones.Results By univariate analysis and logistic regression analysis,the maximum cross-sectional area of stone,pelvicaliceal height(PCH)and S-ReSC score were the independent factors of residual stones after PCNL(P<0.05).According to the results,SPS scoring system was established.AUC of SPS score,STONE score,SHALIN score and S-ReSC score was respectively 0.919,0.778,0.803 and 0.864.AUC of SPS score was significantly larger than that of STONE score and SHA.LIN score(P<0.05).Conclusion PCH,stone maximum cross-sectional area and S-ReSC score are independent factors of residual stones after PCNL.According to the three factors,the SPS score can predict the stone free rate after PCNL well,which is better than STONE score and SHALIN score.

关 键 词：肾结石 经皮肾镜取石术 肾脏解剖结构 结石残留 

分 类 号：R692.4[医药卫生—泌尿科学]