G.E.S.S.O.评分系统的建立及其在微创经皮肾镜取石术中的应用价值

发布时间：2019-02-08 20:28

【摘要】：目的:本研究通过结合现代影像学测得影响微创经皮肾镜取石术清石率及手术的参数,并参考现有肾结石评分建立G.E.S.S.O.(石膏)肾结石评分系统,并探讨将G.E.S.S.O.评分应用于微创经皮肾镜取石术(mPCNL)的临床价值。方法:基于检索并学习相关文献确定变量并建立G.E.S.S.O.评分系统,该评分纳入5个变量,其中包括G(Guy’s结石分级)、E(结石密度)、S(最大累计横截面积)、S(体重指数)、0(肾积水程度)。回顾性收集2015年4月至2016年6月收治的142例行微创经皮肾镜取石术(mPCNL)治疗的肾结石患者的临床资料。结合患者术前泌尿系CTU影像,对影响结石清除的变量进行测量。根据G.E.S.S.O.评分对患者术前结石进行量化分级和评分,分析新型G.E.S.S.O.评分与结石清除状态、手术时间、术中出血量及围手术期并发症等因素之间的关系。结果:(1)本研究共纳入142例行mPCNL的肾结石患者,评分(7.63±1.977)结石清除率为69.7%(99/142),41例(28.9%)出现围手术期并发症。(2)根据统计结果显示结石清除组G.E.S.S.O.评分(6.77±1.276)分,结石残留组(9.60±1.892)分,组间对比差异具有统计学意义(t=-8.986,P=0.000),将G.E.S.S.O.评分划分为5-7分、8-10分、11-14分三组后结石清除率分别为91.0%、53.8%、0.0%,其术前评分越高,术后结石清除率越低。(3)G.E.S.S.O.评分系统与结石清除率(P=0.000)、并发症发生率(P=0.006)及手术时间(P=0.000)均具有相关性,但与术中出血量(P=0.112)、并发症的严重程度(P=0.080)不相关。G.E.S.S.O评分的受试者工作特征曲线的曲线下面积为0.888[95%CI]。结论:G.E.S.S.O.肾结石评分系统能较准确的预测清石率,具有完善病情评估的能力,其有助于评价肾结石手术的复杂程度,且其与术后并发症发生具有相关性,但与术后并发症的严重程度不相关。
[Abstract]:Objective: to study the effects of modern imaging on the removal rate of stone and parameters of microinvasive percutaneous nephrolithotomy, and to establish G.E.S.O. with reference to the existing renal calculi score. (gypsum) Renal calculi scoring system, and to explore G.E.S. O. The clinical value of score in minimally invasive percutaneous nephrolithotomy (mPCNL) was evaluated. Methods: based on the retrieval and study of relevant literature, the variables were identified and G.E.S. O. The scoring system included five variables, including G (Guy's calculus grade,), E (stone density,), S (maximum cumulative cross-sectional area), S (body mass index, and 0 (hydronephrosis degree). The clinical data of 142 patients with renal calculi treated with minimally invasive percutaneous nephrolithotomy (mPCNL) from April 2015 to June 2016 were retrospectively collected. Combined with preoperative CTU imaging of urinary system, the variables affecting stone removal were measured. According to G.E.S. O. A new type of G.E.S.O. The relationship between the score and stone clearance, operative time, intraoperative blood loss and perioperative complications. Results: (1) A total of 142patients with mPCNL were enrolled in this study. The rate of stone clearance was (7.63 卤1.977)% (99 / 142). 41 cases (28.9%) had perioperative complications. (2) according to the statistical results, G.E.S. O. The scores were (6.77 卤1.276) and (9.60 卤1.892) in the residual stone group. The difference between the two groups was statistically significant (t = 8.986, P = 0.000). The calculi clearance rate of the three groups was 91.0 and 53.8% respectively. The higher the preoperative score, the lower the postoperative stone clearance rate. (3) G.E.S.O. the three groups were divided into three groups: 5-7 points, 8-10 points, 11-14 points, and the stone clearance rates were 91.0 and 53.8% respectively. The higher the preoperative score was, the lower the postoperative stone clearance rate was. The scoring system was correlated with stone clearance rate (P0. 000), complication rate (P0. 006) and operative time (P0. 000), but with intraoperative bleeding volume (P0. 112). The severity of complications (P0. 080) was not related. The area under the curve of G.E.S.O score was 0.888 [95%CI]. Conclusion: G.E.S.O. The renal calculi scoring system can accurately predict the rate of stone clearance and has the ability to improve the evaluation of the condition. It is helpful to evaluate the complexity of renal calculi surgery and has a correlation with postoperative complications. However, it was not related to the severity of postoperative complications.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2

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