肾结石评分分级系统对预测PCNL术后结石清除率的对比分析

摘要

Objective To evaluate and compare the accuracy rate of modified Guy's grade,S.N.E sore and SHA.LIN score in the prediction of stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL).Methods A total of 137 patients who underwent PCNL for renal stones were included in the retrospective study.All stones were evaluated with three dimension abdominal computed tomography (3D-CT).The modified Guy's grade,S.N.E and SHA.LIN score were calculated by one urologist.The SFR,operative time,changes of hemoglobin,post-operative hospital stay and complications were recorded.Post-PCNL stone status was evaluated with abdominal plain radiography (KUB).Postoperative complications were graded according to the modified Clavien-Dindo classification,and the correlation of all scoring systems with postoperative complications was investigated.Results The mean modified Guy's grade was 2.75 ± 0.12,S.N.E score was 5.19 ± 0.14,and SHA.LIN score was 9.64±0.20.The overall SFR was 59.85％ (82/137).The cross-sectional area of stone-free patients was (465.0±437.0)mm2.The cross-sectional area of the residual fragment group was (791.1 ±570.9)mm2 (P＜0.001).Postoperative complications occurred in 28 cases (20.4％),including 15 cases of grade Ⅰ (10.9％),8 cases of grade Ⅱ (5.8％),and 5 cases of grade Ⅲ (3.6 ％).The area under the curves (AUC) of modified Guy's grade,S.N.E and SHA.LIN was 0.727 (95 ％ CI:0.642-0.813),0.715 (95％CI:0.627-0.803),and 0.627(95％CI:0.615-0.797),with no significant difference (P=0.124).Conclusion The modified Guy's grade,S.N.E and SHA.LIN score have comparable accuracy in predicting post-PC-NL stone-free status.The three scoring systems are correlated to the operative time,but not with hospital stay,changes of hemoglobin and complications.%目的 评估和比较改良Guy's分级、S.N.E评分、SHA.LIN评分在预测经皮肾镜取石术(PCNL)后结石清除率的准确性及与术后并发症等因素的相关性.方法 回顾性研究137名接受PCNL术患者的临床资料.所有患者均行腹部CT+三维重建,由同一名泌尿外科医师分别对每位患者进行改良Guy's分级、S.N.E评分和SHA.LIN评分,收集术后结石清除情况、手术时间、术后住院天数、术后血红蛋白变化及术后并发症等资料.PCNL术后结石清除状态通过腹部平片进行评估.按Clavien-Dindo系统评估术后并发症,分析不同评分分级与结石清除率及手术时间、术后血红蛋白变化、术后住院时间、术后并发症等的相关性.结果 本组137名患者改良Guy's分级2.75±0.12,S.N.E评分5.19±0.14,SHA.LIN评分9.64±0.20.结石清除率为59.85％(82例),其中结石清除组结石横截累计面积(465.0±437.0)mm2,结石残留组最大结石横截累计面积(791.1±570.9)mm2 (P＜0.001),差异具有统计学意义.术后并发症发生28例(20.4％),其中Ⅰ级15例(10.9％),Ⅱ级8例(5.8％),Ⅲa级5例(3.6％).改良Guy's分级、S.N.E评分、SHA.LIN评分影响PCNL结石清除率的ROC曲线下面积(AUC)分别为0.727(95％CI:0.642～0.813)、0.715(95％CI:0.627～0.803)、0.706(95％CI:0.615～0.797),3个评分分级的AUC差异无统计学意义(P=0.124).结论 改良Guy's分级、S.N.E评分、SHA.LIN评分均能有效预测PCNL术后结石清除率,且差异无统计学意义.3个评分分级系统仅与手术时间相关,与术后住院天数、术后血红蛋白变化及术后并发症不相关.