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目的:研究S.T.O.N.E肾结石评分系统预测经皮肾镜取石术后结石残留的有效性并进行改良。方法:回顾性分析2014年1~12月收治的119例因肾结石行经皮肾镜取石术患者的临床资料,并根据患者术前CT进行S.T.O.N.E评分,分析S.T.O.N.E评分与结石残留、手术时间、术中估计失血量等临床数据的关系并进行改良。结果:结石残留患者与无结石残留患者S.T.O.N.E肾结石评分分别为(8.78±1.34)和(7.25±1.30)分(P=0.000),119例患者S.T.O.N.E肾结石评分分布于5~11分,5~11分患者结石残留率分别为0、6.3%(1例)、30%(9例)、53.6%(15例)、63.6%(14例)、80%(8例)、88.9%(8例)。线性回归模型检验S.T.O.N.E总分与手术时间(P=0.000)、估计失血量(P=0.007)均明显相关,多因素Logistic回归分析S.T.O.N.E总分(P=0.00,OR:2.38,95%CI:1.67~3.40)与结石残留明显相关。多因素Logistic回归分析T评分、O评分与结石残留无明显相关,而S评分(P=0.02,OR:2.13,95%CI:1.13~4.03)、N评分(P=0.00,OR:4.00,95%CI:1.97~8.12)、E评分(P=0.01,OR:5.11,95%CI:1.63~16.10)与结石残留明显相关。删除与结石残留无明显相关的T、O评分,改良后总分称为S.N.E肾结石评分,线性回归模型检验S.N.E评分与手术时间(P=0.000)、估计失血量(P=0.002)明显相关,多因素Logistic回归分析S.N.E肾结石评分与结石残留明显相关(P=0.000,OR:2.683,95%CI:1.803~3.993),S.N.E与S.T.O.N.E肾结石评分预测结石残留AUC值分别为0.794(SE:0.0421,95%CI:0.710~0.863)和0.789(SE:0.0425,95%CI:0.704~0.858),P=0.825。结论:S.T.O.N.E肾结石评分及简化改良的S.N.E评分可有效预测PCNL术后结石残留状态,适于临床及科研应用。
OBJECTIVE: To study the effectiveness of the S.T.O.N.E nephrolithion score system in predicting the residual stone after percutaneous nephrolithotomy. Methods: The clinical data of 119 patients who underwent percutaneous nephrolithotomy underwent renal calculi from January 2014 to December 2014 were analyzed retrospectively. The STONE score was analyzed according to the preoperative CT. The differences of STONE score, residual stones, operative time, In estimating blood loss and other clinical data and improve the relationship. Results: The STONE nephrolithiasis score was (8.78 ± 1.34) and (7.25 ± 1.30) points (P = 0.000) in patients with stone residual disease and no stone residual disease, and 119 cases with STONE nephrolithiasis score in 5 ~ 11 points, Residual stones in 11 patients were 0,6.3% (1 case), 30% (9 cases), 53.6% (15 cases), 63.6% (14 cases), 80% (8 cases) and 88.9% ). The linear regression model test showed that the total score of STONE was significantly correlated with the operation time (P = 0.000) and estimated blood loss (P = 0.007). Logistic regression analysis showed that the total score of STONE (P = 0.00, OR: 2.38, 95% CI: ~ 3.40) was significantly related to residual stones. Multivariate Logistic regression analysis showed that T score and O score had no significant correlation with residual stones, while S score (P = 0.02, OR: 2.13, 95% CI: 1.13-4.03) and N score (P = 0.00, OR: 4.00, % CI: 1.97 ~ 8.12), E score (P = 0.01, OR: 5.11, 95% CI: 1.63 ~ 16.10) was significantly associated with residual stones. The T and O scores were not significantly correlated with residual stones. The improved total score was called the score of SNE nephrolithiasis. The linear regression model test SNE score was significantly correlated with the time of operation (P = 0.000) and the estimated blood loss (P = 0.002) Multivariate logistic regression analysis showed that the SNE nephrolithiasis score was significantly associated with residual stones (P = 0.000, OR: 2.683, 95% CI: 1.803-3.993). The predicted residual AUC values of SNE and STONE nephrolithiasis were 0.794 (SE: 0.0421 , 95% CI: 0.710-0.863) and 0.789 (SE: 0.0425, 95% CI: 0.704-0.858), P = 0.825. Conclusion: The score of S.T.O.N.E nephrolithiasis and the simplified and improved S.N.E score can effectively predict the residual stone status after PCNL, which is suitable for clinical and scientific research.