摘要
目的：探索建立SHA．LIN（砂淋）肾结石评分系统，探讨SHA．LIN评分系统用于经皮肾镜取石术（PCNL）的临床价值。方法通过文献检索及复习确定预测变量并建立SHA．LIN评分系统，评分系统共纳入6个变量，包括S（结石负荷）、H（肾积水程度）、A（解剖分布）、L（通道长度）、I（结石CT值）、N（肾盏数目）。回顾性分析2011年6月至2015年3月收治的116例行PCNL的肾结石患者的临床资料，收集患者的一般情况、术前情况、结石特征及围手术期情况等，利用术前泌尿系CT平扫＋三维重建影像资料，对影响结石清除状态的变量进行测量。根据SHA．LIN评分系统对患者术前结石特征进行评分，分析SHA．LIN评分与结石清除情况、手术时间、估计失血量、住院天数、术后并发症等临床数据的关系。绘制受试者工作特征曲线检测SHA．LIN评分预测结石清除状态的敏感性和特异性。结果116例患者的SHA．LIN评分为（9．13±2．24）分，结石清除率为75．9％（88／116），32例（27．6％）出现术后并发症。结石清除组的SHA．LIN评分为（8．27±1．62）分，残留组为（11．86±1．72）分，组间比较差异有统计学意义（t＝-10．069，P＝0．000）。SHA．LIN评分与术后结石清除状态（P＝0．000）、手术时间（P＝0．000）、估计失血量（P＝0．011）均相关，但与术后并发症及住院天数均不相关（P＞0．05）。SHA．LIN评分受试者工作特征曲线的曲线下面积为0．923，95％CI为0．870～0．975。结论SHA．LIN肾结石评分系统能预测PCNL的术后结石清除状态，具有完善病情评估的作用，但仍应进一步研究以证实其预测围手术期情况及术后并发症的能力。
Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy （ PCNL） and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size （ S） , hydronephrosis （ H） , anatomic distribution （A）, length of tract（L）, indicator of CT（I）, number of involved calices（N） and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic （ ROC） curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%（88/116）.Postoperative complications occurred in 32 （27.6%） cases.In those patients with stone free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 （ t =-10.069, P=0.000） .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss （P〈0.01）.But, it did not correlate with postoperative complications and length of hospital stay （P〉0.05）.The area under curve of ROC curves for the SHA.LIN scoring system was 0.923
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第10期746-751,共6页
Chinese Journal of Urology
关键词
肾结石
肾造口术
经皮
分级
预后
围手术期
Kidney calculi
Nephrostomy,percutaneous
Classification
Prognosis
Peri-operative period
