改良S.T.O.N.E.肾结石评分系统对输尿管软镜碎石术后一期结石清除率的评估价值

Evaluation of modified S.T.O.N.E. nephrolithometry scoring system for predicting the one-phase stone-free rate of flexible ureteroscopic lithotripsy

摘要:

目的：探索改良S.T.O.N.E.肾结石评分系统，探讨改良后的S.T.O.N.E.肾结石评分系统用于一期软性输尿管镜碎石术（flexible ureteroscopic lithotripsy，FURL）后结石清除率的评估价值。方法：检索并分析既往文献，确定预测变量并建立改良S.T.O.N.E.肾结石评分系统，评分系统共纳入5个变量：结石负荷（stone burden，S）、结石位置（topography，T）、梗阻情况（obstruction，O）、累及肾盏数目（number of involved calyces，N）、结石密度（essence of stone，E）。回顾性分析本单位2015年1月至2017年12月322例行FURL的肾结石患者的临床资料，根据术前泌尿系CT平扫影像资料，对影响结石清除状态的变量进行评估。利用改良S.T.O.N.E.肾结石评分系统进行评分，分析改良S.T.O.N.E.评分与结石清除率、手术时间、主要并发症、住院天数等临床结果的关系。绘制受试者工作特征曲线检测改良S.T.O.N.E.评分预测结石清除状态的敏感性和特异性。结果：322例FURL手术均成功完成，一期结石清除率为88.2%。术前平均改良S.T.O.N.E.评分6.4分（4~11分），低分组（4~5分）103例、中分组（6~8分）182例、高分组（9~13分）37例，低分组、中分组和高分组的一期结石清除率分别为98.1%、91.2%和45.9%，组间比较差异有统计学意义（ χ2=74.667，P=0.000）。改良S.T.O.N.E.评分与一期FURL术后结石清除率存在显著相关性（OR=5.614，95%CI=1.811~13.589，P=0.012），受试者工作特征曲线的曲线下面积为0.802（95%CI=0.672~0.920），均高于评分系统中单个变量。结论：改良S.T.O.N.E.肾结石评分系统可有效预测一期FURL术后的结石清除状态，有助于术前评估和临床决策，该模型尚需外部验证进一步研究佐证。

Abstract:

Objective：To modify the S.T.O.N.E. nephrolithometry scoring system for assessing and predicting the stone-free rate（SFR） of flexible ureteroscopic lithotripsy（FURL），and to investigate the predictive value of modified S.T.O.N.E. scoring system for SFR following one-phase FURL. Methods：A literature review was performed to identify clinically relevant and reproducible variables that could affect the SFR of FURL. Five reproducible variables available from preoperative non-contrast computed tomography were measured，including stone burden（S），topography（T），obstruction（O），Number of involved calyces（N），essence of stone（E），which modified the S.T.O.N.E. nephrolithometry scoring system. A retrospective analysis was conducted clinical data of 322 patients with nephrolithiasis undergoing FURL from January 2015 to December 2017. The general conditions，preoperative information，stone characteristics and perioperative variables were collected. The correlation of modified S.T.O.N.E. scores with one-phase SFR，operation time，major complications，hospital stay were analyzed. Receiver operating characteristic（ROC） curves was drawn to detect sensitivity and specificity of modified S.T.O.N.E. scores in predicting the one-phase SFR. Results：The 322 cases’ FURLs were performed suc－cessfully，and the one-phase SFR was 88.2%. The mean modified S.T.O.N.E. score was 6.4（4 to 11） in this cohort. The one-phase SFR was 98.1% in low score（4 to 5） group of 103 cases，91.2% in medium score（6 to 8） group of 182，and 45.9% in high score（9 to 13） group of 37（χ2=74.667，P=0.000）. The modified S.T.O.N.E. score showed significant correlation with SFR following one-phase FURL（OR=5.614，95%CI=1.811 to 13.589，P=0.012），and the area under curve of ROC curves for the modified S.T.O.N.E. score was 0.802（95%CI=0.672 to 0.920），higher than that of each variables in this system. Conclusion：The modified S.T.O.N.E. nephrolithometry scoring system can predict postoperative stone-free status of one-phase FURL. Further research is required to evaluate its performance in external validation.