RUSS评分、改良型S-ReSC评分、R.I.R.S.评分、T.O.HO.评分系统在预测输尿管软镜术后结石清除率的临床应用及对比

【作者】 王聪；

【导师】 鲁军；

【作者基本信息】 南京医科大学 ， 外科学（泌尿外）（专业学位）， 2021， 硕士

【摘要】 目的:通过统计学方法分析出影响输尿管软镜取石(RIRS)术后结石清除率的危险因素,评估并对比四种评分在预测RIRS术后结石清除率的预测价值。方法:对我院符合入组条件的150例在2018年9月至2020年3月间接受RIRS治疗的肾结石患者的病历资料进行回顾性分析。记录每个患者的人口统计学数据和肾结石特征数据,用统计学方法研究各项因素与结石清除率的关系,使用受试者工作特征曲线(ROC)下的面积分析并对比各评分系统对结石清除率的预测价值。结果:在术后一月的复查中,108例患者(72.00%)达到无结石状态,42例患者有1个或多个碎石(28.00%)。无论RIRS术后是否达到无结石状态,患者在肾盂输尿管与下盏夹角(Renal infundibulopelvic angle,RIPA)、受累肾盏长度(Renal infundibular length,RIL)、下盏结石、肾结石密度和结石负荷等结石特征上的差异均有统计学意义(分别为p<0.001,p:0.003,p<0.001,p<0.001,p<0.001)。二元逻辑回归分析显示,RIPA、RIL、下盏结石、肾结石密度和结石负荷也为影响结石清除的独立危险因素。RUSS,改良型S-Re SC,R.I.R.S.和T.O.HO评分系统与术后结石清除率显著相关(P值分别为<0.001,0.002,<0.001,<0.001)。四种评分系统均可预测术后结石清除率。ROC曲线下面积分别为0.706(RUSS评分)、0.666(改良型S-Re SC评分)、0.742(R.I.R.S.评分)、0.682(T.O.HO.评分)。结论:RIPA、RIL、下盏结石、肾结石密度和结石负荷为影响结石清除的独立危险因素,四种评分系统均可预测RIRS术后结石清除率,本研究中,R.I.R.S.评分系统的准确性高于其他三个评分系统。更多还原

【Abstract】 Objective: To analyze the risk factors that affect the stone clearance rate after RIRS by statistical methods,and to evaluate and compare the predictive value of the four scores in predicting the stone clearance rate after RIRS.Methods: A retrospective analysis of the medical records of 150 patients with kidney stones who received RIRS from September 2018 to March 2020 in our hospital.Record demographic data and kidney stone characteristic data of each patient,use statistical methods to study the relationship between various factors and stone residuals,use receiver operating characteristic curve(ROC)analysis and compare the prediction of stone residuals by each scoring model value.Results: In the one-month follow-up examination,108 patients(72.00%)achieved stone-free status,and 42 patients had one or more residual masses(28.00%).Regardless of whether the RIRS reached a stone-free state,the differences in the stone characteristics of the patients such as RIPA,RIL,lower calculus,kidney stone density,and stone load were statistically significant(p<0.001,p: 0.003,p <0.001,p<0.001,p< 0.001).Binary logistic regression analysis showed that RIPA,RIL,lower calyx stones,kidney stone density and stone load are also independent risk factors that affect stone removal.Four scoring systems can predict postoperative stone clearance rate.The areas under the ROC curve were 0.706(RUSS score),0.666(modified S-Re SC score),0.742(R.I.R.S.score),and 0.682(T.O.HO.score).Conclusion: RIPA,RIL,lower calyx stones,kidney stone density and stone load are independent risk factors that affect stone clearance.The four scoring systems can predict the stone clearance rate after RIRS.In this study,the RIRS scoring system is highly accurate for the other three scoring systems.更多还原