Establishment of a new scoring system for the treatment of lower calyceal calculus by retrograde intrarenal surgery
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摘要: 目的 定义针对逆行肾内手术治疗肾下盏结石清石率(stone-free rate，SFR)的新评分系统，同时探讨其预测价值，并与其他评分系统进行比较。方法 以泌尿系CT平扫为依据来测量肾下盏解剖结构和肾下盏结石特征参数，采用上述数据建立排石难度评分系统。回顾性分析2021年9月—2023年2月武汉大学人民医院收治的82例因单纯肾下盏结石行逆行肾内手术治疗的患者临床资料。根据患者术后复查的影像学结果，将患者分为高SFR组与低SFR组。使用统计学方法分析各因素与SFR的关系。分别计算新定义的排石难度评分系统及其他评分系统得分，并用受试者工作特征曲线(ROC)下的面积将排石难度评分系统与另外3种结石评分系统进行对比。结果 排石难度评分系统成功建立，按照选取的结石参数特征的不同分别记为排石难度MAX评分和排石难度AVE评分。本研究82例，高SFR组49例(59.76%)，低SFR组33例(40.24%)。2组患者一般资料差异无统计学意义，在结石最大CT值(P < 0.001)、结石平均CT值(P=0.034)以及结石体积(P=0.029)上的差异均有统计学意义。与术后SFR显著相关的评分系统ROC曲线下面积分别为0.68(排石难度MAX评分)、0.675(排石难度AVE评分)、0.672(ln排石难度MAX评分)、0.676(ln排石难度AVE评分)、0.643(R.I.R.S.评分)和0.623(T.O.HO.评分)。结论 对于肾下盏结石，排石难度评分系统能更好地预测逆行肾内手术的SFR，其中排石难度MAX评分预测效果最好。Abstract: Objective To define a new scoring system for the stone-free rate(SFR) of lower calyceal calculus treated by retrograde intrarenal surgery(RIRS), to explore its predictive value, and to compare it with other scoring systems.Methods The anatomy of the renal calyces and the characteristic parameters of the lower calyceal calculus were measured by non-contrast urological CT scanning, and the stone removal difficulty scoring system was established by using the above data. A retrospective analysis was performed for the clinical data of 82 patients admitted to Renmin Hospital of Wuhan University who underwent RIRS for subrenal calculi from September 2021 to February 2023. According to the plain film of kidney-ureter-bladder(KUB) results of the postoperative review, the patients were divided into high SFR group and low SFR group. The relationship between each factor and the SFR was clarified by statistical analysis method. The scores of the newly defined stone removal difficulty scoring system and other commonly used scoring systems were calculated separately, and the area under curve(AUC) of the receiver operating characteristic curve(ROC) was used to compare the stone removal difficulty scoring system with the other stone scoring systems.Results The stone removal difficulty scoring system was successfully established, and the stone removal difficulty MAX score and the stone removal difficulty AVE score were recorded according to the different characteristics of the selected stone parameters. In this study, according to the results of postoperative KUB, 49 cases(59.76%) were in the high SFR group and 33 cases(40.24%) in the low SFR group. There was no difference in general data between the two groups, but the differences in the maximum CT value of stones(P < 0.001), mean CT value of stones(P=0.034) and stone volume(P=0.029) were statistically significant. The AUC was 0.68(Stone Removal Difficulty MAX score), 0.675(Stone Removal Difficulty AVE score), 0.672(ln Stone Removal Difficulty MAX score), 0.676(ln Stone Removal Difficulty AVE score), 0.643(R.I.R.S. score) and 0.623(T.O.HO. score).Conclusion Compared with other scoring systems, the stone removal difficulty scoring system defined by us can better predict the SFR of RIRS, and the Score of Stone Removal Difficulty MAX has the best prediction effect.
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表 1 2组患者临床资料与肾脏结石特征例(%)，X±S，M(P25，P75)
临床资料 总体(82例) 高SFR组(49例) 低SFR组(33例) P值 性别 0.030a) 男 49(59.76) 34(69.39) 15(30.61) 女 33(40.24) 15(45.45) 18(54.55) 年龄/岁 55.05±13.36 52.90±12.48 58.24±13.98 0.085b) BMI/(kg/m2) 24.51(22.22，26.04) 24.39(23.11，26.04) 25.00(22.09，26.04) 0.688c) 患侧 0.825a) 左 36(43.90) 22(61.11) 14(38.89) 右 46(56.10) 27(58.70) 19(41.30) 尿常规及尿培养 0.575d) 阴性 78(95.12) 47(60.26) 31(39.74) 阳性 4(4.88) 2(50.00) 2(50.00) 肾脏解剖变异 0.387d) 是 5(6.10) 2(40.00) 3(60.00) 否 77(93.90) 47(61.04) 30(38.96) 套石篮或负压吸引 1.000d) 是 10(12.20) 6(60.00) 4(40.00) 否 72(87.80) 43(59.72) 29(40.28) 预置输尿管支架 0.898a) 是 23(28.05) 14(60.87) 9(39.13) 否 59(71.95) 35(59.32) 24(40.68) 术者 0.815d) A 13(15.85) 7(53.85) 6(46.15) B 19(23.17) 11(57.89) 8(42.11) C 7(8.54) 3(42.86) 4(57.14) D 14(17.07) 9(64.29) 5(35.71) E 29(35.37) 19(65.52) 10(34.48) 肾积水 0.941a) 无 60(73.17) 36(60.00) 24(40.00) 有 22(26.83) 13(59.09) 9(40.91) 结石长径/mm 11.75(9.72，15.53) 11.17(9.17，15.19) 13.26(10.85，16.64) 0.065c) 结石体积/mm3 510.23(244.85，1 032.76) 415.08(228.64，742.56) 740.99(308.80，1 383.94) 0.029c) 结石CT最大值/HU 1 533.29±333.58 1 430.00±354.42 1 686.67±225 <0.001b) 结石CT平均值/HU 763.37±290.41 707.46±255.49 846.39±317.96 0.034b) IL/mm 25.48±4.55 25.37±4.31 25.65±4.87 0.796b) ILA角度/° 39.28(31.27，45.82) 40.28(33.01，47.60) 33.19(29.84，43.48) 0.070c) CPH/mm 19.22±5.00 18.70±4.60 20.01±5.44 0.267b) IPA/° 41.5±15.88 41.96±14.69 40.8±17.47 0.758b) 注：a)χ2检验，b)独立样本t检验，c)Mann-Whitney U检验，d)Fisher精确检验。 
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表 2 二元逻辑回归分析
因素 P值 Exp(B) 95%置信区间 结石体积 0.127 1 0.999~1.000 结石CT最大值 0.009 0.997 0.999~0.999 结石CT平均值 0.924 1 0.999~1.002
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表 3 各评分系统得分情况
X±S 评分系统 总体 高SFR组 低SFR组 P值 排石难度MAX 26 429.73±31 646.65 17 189.51±19 396.10 40 150.04±40 186.61 0.006 排石难度AVE 13 017.71±18 413.17 7 648.21±7 704.53 20 990.61±25 455 0.007 RUSS评分 0.76±0.64 0.71±0.61 0.82±0.67 0.557 R.I.R.S.评分 7.61±0.88 7.41±0.88 7.91±0.79 0.020 T.O.HO.评分 6.61±1.01 6.39±0.85 6.94±1.13 0.047 ln排石难度MAX 9.60±1.27 9.27±1.14 10.09±1.29 0.007 ln排石难度AVE 8.78±1.17 8.49±1.07 9.21±1.17 0.006
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表 4 各评分系统AUC
评分系统 ROC曲线下面积 P值 95%CI 排石难度MAX 0.68 0.006 0.556~0.803 排石难度AVE 0.675 0.007 0.549~0.802 R.I.R.S.评分 0.643 0.029 0.524~0.762 T.O.HO.评分 0.623 0.060 0.498~0.748 ln排石难度MAX 0.672 0.008 0.551~0.794 ln排石难度AVE 0.676 0.007 0.554~0.798
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表 5 各评分系统的分界值
例(%) 评分系统 总体(82例) 高SFR组(49例) 低SFR组(33例) P值 排石难度MAX 0.001a) >17 008.8 34(41.46) 13(38.24) 21(61.76) <17 008.8 48(58.54) 36(75.00) 12(25.00) 排石难度AVE 0.001b) >16 792.0 18(21.95) 3(16.67) 15(83.33) <16 792.0 64(78.05) 46(71.88) 18(28.13) R.I.R.S.评分 0.078a) >7.5 45(54.88) 23(51.11) 22(48.89) <7.5 37(45.12) 26(70.27) 11(29.73) ln排石难度MAX 0.004a) >10.5 17(20.73) 5(29.41) 12(70.59) <10.5 65(79.27) 44(67.69) 21(32.31) ln排石难度AVE 0.004a) >9.5 23(28.05) 8(34.78) 15(65.22) <9.5 59(71.95) 41(69.49) 18(30.51) 注：a)χ2检验，b)Fisher精确检验。
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表 6 各评分系统的比较
评分指标 结石位置和数量 CT值 结石负荷 IPA IL CPH 肾积水 肾解剖畸形 改良S-ReSC评分 √ H.L.P.E.S评分 √ √(表面积) √ √ √ RUSS评分 √ √(长径) √ √ R.I.R.S.评分 √ √ √(长径) √ √ T.O.HO.评分 √ √ √(长径) S.O.L.V.E.评分 √ √ √(表面积) √ √ S.T.O.N.E.评分 √ √ √(长径) √ 排石难度评分 √ √(体积) √
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[1] Ye ZQ, Zeng GH, Yang H, et al. The status and characteristics of urinary stone composition in China[J]. BJU Int, 2020, 125(6): 801-809. doi: 10.1111/bju.14765
[2] 苏潇哲, 赵延春, 杨嗣星. 1990—2019年中国尿路结石疾病负担和变化趋势分析[J]. 临床泌尿外科杂志, 2023, 38(8): 627-631. doi: 10.13201/j.issn.1001-1420.2023.08.013
[3] Sharbaugh A, Morgan Nikonow T, Kunkel G, et al. Contemporary best practice in the management of staghorn calculi[J]. Ther Adv Urol, 2019, 11: 1756287219847099.
[4] Vordos N, Giannakopoulos S, Gkika DA, et al. Kidney stone nano-structure-Is there an opportunity for nanomedicine development?[J]. Biochim Biophys Acta Gen Subj, 2017, 1861(6): 1521-1529. doi: 10.1016/j.bbagen.2017.01.026
[5] Rehman OU, Imran M, Rafaqat M, et al. Outcomes in lower pole kidney stone management using mini-percutaneous nephrolithotomy compared with retrograde intra renal surgery: a randomized controlled trial[J]. Cureus, 2023, 15(2): e35343.
[6] Liu X, Xia D, Peng EJ, et al. Comparison of two techniques for the management of 2-3 cm lower pole renal calculi in obese patients[J]. World J Urol, 2022, 40(2): 513-518. doi: 10.1007/s00345-021-03872-6
[7] Danilovic A, Torricelli FCM, Marchini GS, et al. Residual stone fragments after percutaneous nephrolithotomy: shockwave lithotripsy vs retrograde intrarenal surgery[J]. J Endourol, 2021, 35(5): 609-614. doi: 10.1089/end.2020.0868
[8] Bosio A, Alessandria E, Dalmasso E, et al. Flexible ureterorenoscopy versus shockwave lithotripsy for kidney stones ≤2 cm: a randomized controlled trial[J]. Eur Urol Focus, 2022, 8(6): 1816-1822. doi: 10.1016/j.euf.2022.04.004
[9] Kahraman O, Dogan HS, Asci A, et al. Factors associated with the stone-free status after retrograde intrarenal surgery in children[J]. Int J Clin Pract, 2021, 75(10): e14667.
[10] Lim EJ, Teoh JY, Fong KY, et al. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys[J]. Minerva Urol Nephrol, 2022, 74(6): 738-746.
[11] Ito H, Kawahara T, Terao H, et al. Re: Ito et al. : The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience (Urology 2012;80: 524-528). Reply by the authors[J]. Urology, 2013, 81(1): 217.
[12] Resorlu B, Unsal A, Gulec H, et al. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score"[J]. Urology, 2012, 80(3): 512-518. doi: 10.1016/j.urology.2012.02.072
[13] Xiao YL, Li D, Chen L, et al. The R.I.R.S. scoring system: an innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery[J]. BMC Urol, 2017, 17(1): 105. doi: 10.1186/s12894-017-0297-0
[14] Hori S, Otsuki H, Fujio K, et al. Novel prediction scoring system for simple assessment of stone-free status after flexible ureteroscopy lithotripsy: T.O. HO. score[J]. Int J Urol, 2020, 27(9): 742-747. doi: 10.1111/iju.14289
[15] Jung JW, Lee BK, Park YH, et al. Modified Seoul National University Renal Stone Complexity score for retrograde intrarenal surgery[J]. Urolithiasis, 2014, 42(4): 335-340. doi: 10.1007/s00240-014-0650-7
[16] 古江林, 罗生军, 蒋立, 等. 结合虚拟现实技术的H.L.P.E.S. 评分系统对输尿管软镜术后结石清除率的预测价值[J]. 中华泌尿外科杂志, 2022, 43(5): 384-386. https://cdmd.cnki.com.cn/Article/CDMD-10631-1022651247.htm
[17] 罗生军, 胡豪, 胡代星, 等. S.O.L.V.E. 评分系统预测输尿管软镜术后结石清除率的临床应用价值[J]. 中华泌尿外科杂志, 2018, 39(9): 661-666. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWZ202201003.htm
[18] Molina WR, Kim FJ, Spendlove J, et al. The S.T.O.N.E. Score: a new assessment tool to predict stone free rates in ureteroscopy from pre-operative radiological features[J]. Int Braz J Urol, 2014, 40(1): 23-29. doi: 10.1590/S1677-5538.IBJU.2014.01.04
[19] Merigot de Treigny O, Bou Nasr E, Almont T, et al. The cumulated stone diameter: a limited tool for stone burden estimation[J]. Urology, 2015, 86(3): 477-481. doi: 10.1016/j.urology.2015.06.018
[20] Tastemur S, Senel S, Kizilkan Y, et al. Evaluation of the anatomical factors affecting the success of retrograde intrarenal surgery for isolated lower pole kidney stones[J]. Urolithiasis, 2022, 50(1): 65-70. doi: 10.1007/s00240-021-01279-x
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