S.T.O.N.E评分系统及其改良对经皮肾镜碎石取石术后结石清除状态的预测研究

Predictive value of S.T.O.N.E scoring system and its improvement on stone clearance after percutaneous nephrolithotomy

摘要:

探讨S.T.O.N.E肾结石评分系统对预测经皮肾镜碎石取石术后结石清除状态的利用价值并改进。方法 对符合纳入条件的经皮肾镜碎石取石术患者进行术前S.T.O.N.E肾结石评分，分析S.T.O.N.E评分系统及其所包含的各子项因素与术后结石清除状态的相关性，并进行改进。结果 146例患者结石清除率为73.97%。二元Logistic回归分析S.T.O.N.E总评分（OR=2.033，95%CI：1.469～2.814，P =0.000）与结石残留显著相关。多因素Logistic回归分析S评分（OR=4.003，95%CI：1.930～8.300，P =0.000）和N评分（OR=2.159，95%CI：1.042～4.476，P =0.038）是结石残留的显著影响因子。T、O、E评分未见相关性（P >0.05）。剔除T评分，引入结石的位置（L）信息。结石没有累及肾上极得1分，累及到肾上极得2分，称作L评分。改进O评分方法，积水程度反映了手术可操作空间（I）的大小，规定轻度积水和中度积水评1分，无积水和重度积水评2分，称作I评分。改良后的S.T.O.N.E肾结石评分与结石残留显著相关（OR=2.400，95%CI：1.730~3.328，P =0.000）。多因素Logistic回归分析L评分（OR=4.421，95%CI：0.989～19.757，P =0.052）、I评分（OR=2.726，95%CI：1.119～6.642，P =0.027）和S评分（OR=3.962，95%CI：1.903～8.247，P =0.000）与结石残留显著相关，N、E评分未见相关性（P >0.05）。改良的S.T.O.N.E（L.I.N.E.S）和S.T.O.N.E评分预测结石残留的受试者工作特征曲线（ROC）下面积（AUC）分别为0.7997（SE=0.043，95%CI：0.716～0.884）和0.7483（SE=0.047，95%CI：0.656～0.840），差异具有统计学意义（χ2=4.81，P =0.028）。结论 改良的S.T.O.N.E（L.I.N.E.S）评分和S.T.O.N.E肾结石评分系统均可用来预测术后结石清除状况，改良的S.T.O.N.E评分操作更简便，预测准确性更高。

Abstract:

To investigate the value of S.T.O.N.E scoring system in predicting of stone clearance after PCNL and how to improve it.?Methods?Clinical data of eligible patients was analyzed. The preoperative stone was scored according S.T.O.N.E. scoring system. The correlation between S.T.O.N.E scoring system and its sub-factors and the status of stone clearance after operation was analyzed. The S.T.O.N.E scoring system was improved.?Results?The stone free rate was 73.97%. The total score of S.T.O.N.E was significantly correlated with residual stones (OR = 2.033, 95%CI: 1.469 ~ 2.814, P = 0.000). Multivariate Logistic regression analysis showed that S score (OR = 4.003, 95%CI: 1.930 ~ 8.300, P = 0.000) and N score (OR = 2.159, 95%CI: 1.042 ~ 4.476, P = 0.038) were the significant influencing factors of residual stones. There was no significant correlation between T, O and E scores (P ﹥ 0.05). The T score was removed and the information of location (L) was leaded into. If there were no stones in upper pole of kidney, it was 1 point. If upper pole of kidney had stone, it was 2 points. The method of O scoring was improved. The degree of hydrocele reflected the size of the operative interspaces (I). If the degree of hydrocele was mild or moderate, it was 1 point. If the degree of hydrocele was nil or severe, it was 2 points. The improved S.T.O.N.E scoring was significantly correlated with residual calculi (OR = 2.400, 95%CI: 1.730~3.328, P = 0.000). By multivariate logistic regression analysis, L score (OR = 4.421, 95%CI: 0.989 ~ 19.757, P = 0.052), I score (OR = 2.726, 95%CI: 1.119 ~ 6.642, P = 0.027), S score (OR = 3.962, 95%CI: 1.903 ~ 8.247, P = 0.000) were significantly correlated with residual calculi. There was no significant correlation between N and E scores (P ﹥ 0.05). The area of ROC curves of the improved S.T.O.N.E score and S.T.O.N.E score was 0.7997 (SE = 0.043, 95%CI: 0.716 ~ 0.884) and 0.7483 (SE = 0.047, 95%CI: 0.656 ~ 0.840), respectively. There were significant differences (χ2 = 4.81, P = 0.028).?Conclusion?The improved S.T.O.N.E scoring and S.T.O.N.E scoring system can be used to predict stone clearance. The improved S.T.O.N.E score is easier to operate and more accurate to predict.