S-ReSC评分系统对经皮肾镜取石术结石清除的预测价值

摘要

Objective To assess the predictive value of S-ReSC scoring system on stoneclearance after percutaneous nephrolithotomy. Methods From January 2012 toJanuary 2015,91patients admitted to our hospital received PCNL were divided into clear group(n=66) and residual group(n=25) according to whether the stones were removed. The two groups of patients were compared from the general information and operation situation,and their S-ReSC score were calculated according to S-ReSC scoring system. Logistic multiple factors regression analysiswas adopted to analyze the relationship between clearance results and the variables,and the receiver-operating characteristic curve( ROC) were drew to analyzethe sensitivity and specificity of S-ReSC score system on predictingstone clearance rate,to calculate the area under the ROC curve( AUC) ,and to calculatetheYoudenindex of S-ReSC. Results There were 66 cases(72. 5%) of clearance in 91 patients. Patients were divided into the low score group (1~2points),the middle score group(3~4points) and the high score group(5~9 points)according to the S-ReSC score. There were 44 cases in the low score group,in which the clearance rate was 95. 5%;There were 28 cases in the middle score group,in which the clearance rate was68. 0%;There were 32 cases in the high score group,in which the clearance rate was 31. 8%;The difference of clearance rate among the three groups was statistically significant(P<0. 05). As to operation situation,the number of affected calyces,operation time,blood loss,hospital stay,and anatomical distributionof the stones of residual group were higher than clear group,and the differences were statistically significant(P<0. 05). The S-ReSC score of clear groupwas(2. 16 ± 1. 31)points, while the residual group was(4. 17 ± 1. 14) points,statistically significant(P<0. 05). In Logistic regression analysis,stones clear-ance situation as the dependent variable( = 0,residual=1),and the patient's general condition,operation situation,S-ReSC score as the independent variables,results found that the affected renal calyx number,operation time,S-ReSC score were the influence factors of stone clearance. According the result of daily KUB taken,the AUCof S-ReSC score was 0. 885,and the largestYouden in-dexwas 0. 618when S-ReSC score≥3. 5. Conclusion S-ReSC score system is simple,practical,specific,and accurate,which is valuable to predict the clearance of stone after percutaneous nephrolithotomy.%目的 评估S-ReSC评分系统对经皮肾镜取石术结石清除的预测价值.方法 纳入2012年1月至2015年1月我院收治的91例行PCNL的患者,根据术后结石是否清除分为清除组(n=66)与残留组(n=25).比较两组患者的一般资料及手术情况,由研究人员根据S-ReSC评分系统进行计算患者S-ReSC评分,采用Logistic多因素回归分析结石清除结果与各变量间的关系,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析S-ReSC评分预测结石清除率的敏感性和特异性,计算S-ReSC评分的ROC曲线下面积(AUC),计算S-ReSC评分的约登指数.结果 91例患者共66例清除,清除率72.5%.将S-ReSC评分划分为低分组(1~2分)、中分组(3~4分)及高分组(5~9分),其中低分组共44例,清除率95.5%;中分组共25例,清除率68.0%;高分组共22例,清除率31.8%;三组间清除率差异有统计学意义(P<0.05).手术情况比较,残留组受累肾盏数、手术时间、失血量、住院时间、结石解剖分布均高于清除组,差异均有统计学意义(P<0.05).清除组S-ReSC评分为(2.16±1.31)分,残留组为S-ReSC评分为(4.17±1.14)分,差异有统计学意义(P<0.05).将结石是否清除为因变量(清除=0,残留=1),将患者的一般情况、手术情况、S-ReSC评分为自变量进行Logistic回归分析,结果发现受累肾盏数、手术时间、S-ReSC评分为结石清除的影响因素.依据当日摄KUB的结果为标准,S-ReSC评分的AUC为0.885,当S-ReSC评分≥3.5时,约登指数最大,为0.618.结论 S-ReSC评分系统简单、实用、具体、准确,可以较准确地预测术后结石清除情况.