S.T.O.N.E.评分系统和Guy's分级法预测经皮肾镜碎石效果的比较

摘要

Objective To compare and verify the significance of S.T.O.N.E.nephrolithometry scoring system and Guy's stone score in the prediction of the outcomes of percutaneous nephrolithotomy (PCNL).Methods The clinical data of 97 patients undergoing PCNL were retrospectively analyzed.The S.T.O.N.E.score and Guy's stone score were reviewed and calculated by one observer.Logistic regression analysis was performed and receiver operating characteristic (ROC) curves were drawn to compare the differences in stone-free rate (SFR) and complications.Results All operations were successfully conducted.Both systems were significant when stone-free patients and those with residual stones were compared (P=0.000).Logistic regression revealed that both scoring systems (P =0.000),stone accumulated calyces number (P =0.000),stone load (P 0.000),blood loss (P=0.004) and operation time (P =0.049) were associated with stone-free status.The area under the curve (AUC),sensibility and specificity for S.T.O.N.E.scoring system was 0.804,75.9 ％ and 74.4 ％,while the AUC,sensibility and specificity for Guy's stone score was 0.865,72.4％ and 92.3％.Complications occurred in 29 patients (29.8％).Logistic regression revealed that BMI (P=0.024) and hospitalization days (P=0.000) were associated with complications.Conclusion S.T.O.N.E.nephrolithometry scoring system and Guy's stone score can predict PCNL stone-free status,operation time and blood loss,but can not predict hospitalization days and postoperative complications.The two systems have their own advantages and can supplement each other.%目的 比较S.T.O.N.E.结石评分系统与Guy's结石分级方法预测经皮肾镜碎石(PCNL)清除率及并发症的价值并结合PCNL相关的肾解剖指标进行验证.方法 回顾性分析我院97例行PCNL治疗的肾结石患者.分别应用两个评分系统进行肾结石状况的评估,对比不同评分的患者在结石清石率和并发症的差异.结果 97例患者手术均顺利完成.S.T.O.N.E.评分系统结石清除组与残留组比较差异有统计学意义(P=0.000).Guy's评分组间对照差异有统计学意义(P=0.000).在Logistic回归模型中,S.T.O.N.E.评分(P=0.000)、结石累计肾盏数(P=0.000)、结石负荷(P=0.000)、Guy's评分(P—0.000)、术中出血(P=0.004)和手术时间(P=0.049)与结石清除状况相关.绘制受试者工作特征曲线(ROC)提示S.T.O.N.E.评分系统的曲线下面积(AUC)为0.804,敏感性为75.9％oo,特异性为74.4％;Guy's分级系统AUC为0.865,敏感性为72.4％,特异性为92.3％.术后29例(29.8％)患者出现并发症.在Logistic回归模型中,BMI(P=0.024)、术后住院天数(P=0.000)与并发症相关.结论S.T.O.N.E.评分系统和Guy's分级法可以有效预测PCNL术后结石清除状态、术中出血量、手术时间,但无法预测并发症、住院时间,其有各自的侧重点,可以相互补充.