Clinical application of SHA. LIN, S.T.O.N.E. scoring system and Guy’s classification method in predicting calculus clearance rate after flexible ureteroscopy and risk factors for reducing clearance rate
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摘要: 目的:分析SHA.LIN、S.T.O.N.E.评分系统和Guy's分级法在预测输尿管软镜术后结石清除率的临床应用及降低清除率的风险因素。方法:回顾性分析2016年2月~2018年12月我院收治的105例行输尿管软镜术患者的临床资料,根据术后结石清除状态分为结石清除组(n=76)、残留组(n=29),比较两组SHA.LIN评分、S.T.O.N.E.评分、Guy's分级、最大累计截面积、肾积水情况、结石数量、结石CT值、结石解剖位置、受累肾盏数目分布情况,统计SHA.LIN评分(6~9分、10~13分、14~17分)、S.T.O.N.E.评分(5~6分、7~8分、9~13分)及Guy's分级(GⅣ、Ⅲ、Ⅱ、Ⅰ级)患者分布及结石清除率情况,比较3种评分ROC曲线下与坐标轴围成的面积(AUC),并统计各评分预测结石清除率敏感度、特异度,并以Spearman对降低结石清除率风险因素进行相关性分析。结果:残留组SHA.LIN评分、S.T.O.N.E.评分高于清除组,且两组Guy's分级比较差异有统计学意义(P<0.05);SHA.LIN评分6~9分、10~13分、14~17分患者结石清除率分别为95.77%(68/71)、30.00%(9/30)、0(0/4);S.T.O.N.E.评分5~6分、7~8分、9~13分患者结石清除率分别为95.00%(19/20)、86.44%(51/59)、34.62%(9/26);Guy's分级Ⅳ、Ⅲ、Ⅱ、Ⅰ级患者结石清除率分别为22.22%(2/9)、72.34%(34/47)、85.71%(36/42)、100.00%(7/7);SHA.LIN评分AUC高于S.T.O.N.E.评分、Guy's分级,S.T.O.N.E.评分AUC高于Guy's分级(P<0.05);SHA.LIN评分ADC为10分时,敏感度、特异度分别为79.6%、87.82%;S.T.O.N.E.评分ADC为8分时敏感度、特异度分别为71.62%、66.33%;Guy's分级ADC为Ⅲ级时,敏感度、特异度分别为57.91%、83.86%;清除组与残留组肾积水情况、结石数量比较差异无统计学意义(P>0.05);残留组最大累计截面积、结石CT值大于清除组,结石解剖位置、受累肾盏数目分布情况组间比较差异有统计学意义(P<0.05);最大累计截面积较大、结石CT值较高、结石解剖位置隐蔽、受累肾盏数目较多与低结石清除率呈正相关(P<0.05)。结论:输尿管软镜术结石清除率随Guy's分级、S.T.O.N.E.评分、SHA.LIN评分升高而降低,三者预测结石清除率价值依次升高,其中SHA.LIN评分评定时各参数均可量化,客观性高,最大累计截面积较大、结石CT值较高、结石解剖位置隐蔽、受累肾盏数目较多是降低清除率独立危险因素。Abstract: Objective: To analyze the clinical application of SHA. LIN, S.T.O.N.E. scoring system and Guy's classification method in predicting calculus clearance rate after flexible ureteroscopy and the risk factors for reducing clearance rate. Method: A retrospective analysis of 105 patients who underwent flexible ureteroscopy in our hospital from February 2016 to December 2018 was done, and these patients were divided into stone removal group(n=76) and residual group(n=29) according to postoperative stone removal status. SHA. LIN score, S.T.O.N.E. score, Guy's grade, maximum cumulative cross-sectional area, hydronephrosis, number of stones, CT value of stone, anatomical location of stone, distribution of number of affected renal pelvis between the two groups were compared, and we gathered statistics of patient distribution and stone clearance rate of SHA. LIN scores 6-9, 10-13, 14-17, S.T.O.N.E. scores 5-6, 7-8, 9-13, and Guy's grade Ⅳ, Ⅲ, Ⅱ, Ⅰ. The area enclosed by the coordinate axis(AUC) under the three scoring ROC curves were compared, and the sensitivity and specificity of the stone scavenging rate were predicted by each score. The correlation analysis was carried out by Spearman to reduce the risk factors of stone removal rate. Result: SHA. LIN score and S.T.O.N.E. score of the residual group were higher than those of the clear group, and the difference between the two groups was statistically significant(P<0.05). The stone clearance rate of patients with SHA. LIN score of 6-9, 10-13 and 14-17 were 95.77%(68/71), 30.00%(9/30), and 0(0/4), respectively. The stone removal rate of patients with S.T.O.N.E. scores of 5-6, 7-8 and 9-13 respectively were 95.00%(19/20), 86.44%(51/59) and 34.62%(9/26). The rate of stone removal in Guy's grade Ⅳ, Ⅲ, Ⅱ and Ⅰ patients were 22.22%(2/9), 72.34%(34/47), 85.71%(36/42) and 100.00%(7/7), respectively. SHA. LIN score AUC was higher than that of S.T.O.N.E. score and Guy's grade, and S.T.O.N.E. score AUC was higher than that of Guy's grade(P<0.05). When the SHA. LIN score ADC was 10 points, the sensitivity and specificity were 79.6% and 87.82% respectively. When the S.T.O.N.E. score ADC was 8 points, the sensitivity and specificity were 71.62% and 66.33% respectively. When the Guy's graded ADC was Ⅲ, the sensitivity and specificity were 57.91% and 83.86% respectively. There was no significant difference in hydronephrosis or calculi between removal group and residual group(P>0.05). The maximum cumulative cross-sectional area and CT value of the removal group were larger than those of the clear group, and the anatomical position of the stone and the distribution of the number of affected renal pelvis were statistically significant(P<0.05). Large cumulative cross-sectional area, highe CT value of the stone, hidden anatomical location of the stones and the large number of affected renal pelvis were positively correlated with the low stone clearance rate(P<0.05).Conclusion: The calculus clearance rate of flexible ureteroscopy decreased with the increase of Guy's grade, S.T.O.N.E. score and SHA. LIN score. The value of predicting stone clearance rate increased one by one in Guy's grade, S.T.O.N.E. score and SHA. LIN score. The parameters of SHA. LIN score can be quantified and objective. High maximum cumulative cross-sectional area, high CT value of the stone, hidden anatomical location of the stone and a large number of affected renal pelvis are independent risk factors for reducing the clearance rate.
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Key words:
- SHA.LIN score /
- flexible ureteroscopy /
- S.T.O.N.E. score /
- stone clearance rate /
- Guy's classification /
- risk factors
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