摘要目的 建立S.O.L.V.E.评分系统,探讨其预测输尿管软镜治疗上尿路结石术后结石清除率(SFR)的价值.方法 建立S.O.L.V.E.评分系统,共纳入5个预测变量:结石表面积(stone surface area,S)、梗阻程度(obstruction,O)、肾盏漏斗部长度(length of calyces funnel,L)、累及肾盏数(visible number of calyces,V)、结石密度(essence ofstone,E).回顾性分析2017年1月至2018年6月收治的392例行输尿管软镜治疗的上尿路结石患者的临床资料,男258例,女134例.年龄15～85岁,平均(49.5±12.6)岁.根据术后结石残留情况,分为无残留组292例,男197例,女95例;平均年龄(49.2±12.8)岁;既往有结石手术史37例;中位体重指数24.7 kg/m2(18.1 ～29.0 kg/m2);术前血肌酐中位值72.5 μmol/L(48.9 ～ 84.8μmol/L);结石位于左侧155例,右侧137例;结石位于输尿管19例,肾盂16例,肾下盏87例,肾下盏以外肾盏170例.结石残留组100例,男61例,女39例;平均年龄(50.4±12.0)岁;中位体重指数25.0 kg/m2(18.5 ～ 28.8 kg/m2);术前血肌酐中位值73.8μmol/L(46.5～92.5 μmol/L);既往有结石手术史15例;结石位于左侧51例,右侧49例;结石位于输尿管7例,肾盂4例,肾下盏27例,肾下盏以外肾盏62例.基于392例术前泌尿系CT平扫+三维重建影像学资料,对S.O.L.V.E.评分系统5个预测变量进行测量,并对患者结石特征进行评分.比较无残留组和残留组S.O.L.V.E.评分各项指标的差异.根据S.O.L.V.E.评分将患者分为低分组(4～5分)、中分组(6～8分)、高分组(9～11).比较不同S.O.L.V.E.评分组间术后SFR、术后住院时间、术后并发症、手术时间的差异.采用受试者工作特征曲线(ROC)检测S.O.L.V.E.评分系统预测SFR的价值.结果 本研究392例手术均顺利完成.术后总体SFR为74.5％(292/392).单因素分析结果显示,无残留组和残留组S.O.L.V.E.评分各项指标中,S分别为(82.6±69.8)mm2和(172.6±133.7)mm2,L分别为(12.7 ±15.8)mm和(23.9±15.3) mm,V分别为(0.6±0.7)个和(1.3±0.8)个,E分别为(817.1 ±285.5) HU和(902.4 ±256.1)HU,差异均有统计学意义(P＜0.01);O分别为(17.7±10.9) mm和(19.3±13.1) mm,差异无统计学意义(P=0.242).392例术前S.O.L.V.E.评分平均为6.3分(4～11分),其中低分组139例,中分组217例,高分组36例.低分组、中分组、高分组手术时间分别为(31.6±10.9)、(42.3±18.3)、(58.0±19.2) min,术后SFR分别为93.5％ (130/139)、70.5％(153/217)、37.5％ (9/36),差异均有统计学意义(P＜0.01);术中出血量(P=0.185)、术后感染性发热例数(P =0.893)、术后住院时间(P=0.113)差异均无统计学意义.Logistic回归分析结果显示S、L、V与SFR呈显著相关(P＜0.01),而O、E与SFR无相关性(P＞0.05).S.O.L.V.E.评分的ROC曲线下面积为0.782,高于评分中任何一个变量(S、O、L、V、E分别为0.738、0.535、0.698、0.735、0.593).结论 结石表面积、肾盏漏斗部长度、累及肾盏数与输尿管软镜术后SFR显著相关,S.O.L.V.E.评分系统可有效预测上尿路结石行输尿管软镜治疗后的结石清除情况,有助于临床决策.

abstractsObjective To establish S.O.L.V.E.nephrolithometry scoring system,and to evaluate value of S.O.L.V.E.scoring system for predicting the stone-free rate (SFR) of flexible ureteroscopy (FURS).Methods Five reproducible variables were included in S.O.L.V.E.scoring system,such as stone surface area (S),obstruction (O),length of calyces funnel (L),visible number of calyces (V) and essence of stone (E).Variables were measured based on preoperative non-contrast computed tomography of urography.Clinical data of 392 patients who underwent FURS for upper urinary tract stones in our department from January,2017 to Jnne,2018 were retrospectively analyzed.The total study population consisted of 258 male and 134 female patients.The mean age was (49.5 ± 12.6) years old,ranged from 15 to 85 years.There were 292 patients in stone-fiee group,including 197 male and 95 female patients.The average age was (49.2 ± 12.8) years old.37 patients had previous history of renal stone surgery.Median body mass index was 24.7 kg/m2 (18.1-29.0 kg/m2) and median value of preoperative serum creatinine was 72.5 μmol/L (48.9-84.8 μmol/L).The number of patients,whose stone located in the left side and right side were 155 and 137,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 19,16,87,170,respectively.There were 100 patients in non-stone free group,61 men and 39 women.The average age was (50.4 ± 12.0) years old.15 patients had previous history of renal stone surgery.Median body mass index was 25.0 kg/m2 (18.5-28.8 kg/m2) and median value of preoperative serum creatinine was 73.8 μmol/L (46.5-92.5 μnol/L).The number of patients,whose stone located in the left side and right side were 51 and 49,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 7,4,27,62,respectively.The correlation of S.O.L.V.E.scoring system and stone-free rate,postoperative hospital stay,surgical complications,operation time were analyzed.Receiver operating characteristic curves were drawn to detect predictive value of S.O.L.V.E.scoring system for SFR of FURS.Results All cases FURS were performed successfully and the SFR was 74.5％ (292/392).Among the variables of the S.O.L.V.E.scoring system in the stone-free group and the non-stone free group,item S were (82.6 ± 69.8) mm2 and (172.6±133.7)mm2,respectively.The item L were (12.7 ± 15.8) mm and (23.9 ± 15.3)mm,respectively.The item V were (0.6 ± 0.7) and (1.3 ± 0.8),respectively.The item E were (817.1 ± 285.5) HU and (902.4 ± 256.1) HU,respectively.The difference was statistically significant (P ＜ 0.01).The item O was (17.7 ± 10.9) mm and (19.3 ± 13.1) mm,respectively,no statistical significance was found (P =0.242).The mean score was 6.3 (ranging 4-11) in this c ohort.The patients were divided into low score (4-5) group,moderate score (6-8) group and high score (9-11) group due to S.O.L.V.E.scoring system,and the stone-free rates were 93.5％ (130/139),70.5％ (153/217) and 37.5％ (9/36),respectively (P ＜0.01).The operation time of low,moderate,andi high score group were (31.6 ± 10.9),(42.3 ± 18.3),and (58.0 ± 19.2) min,respectively.Additionally,the score was correlated with the operation time(P ＜0.01),but not with postoperative hospital stay (P =0.133),intraoperative bleeding (P =0.185) and postoperative infectious fever (P =0.839).In logistic regression model analysis,the stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR (P ＜ 0.01).The obstruction degree and essence of stone were not associated with SFR (P ＞ 0.05).The area under receiver operating characteristic curve of S.O.L.V.E.score was 0.782,higher than that of each variable in S.O.L.V.E.scoring system(S,O,L,V,E were 0.738,0.535,0.698,0.735,0.593,respectively).Conclusions The stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR.The S.O.L.V.E.nephrolithometry scoring system can predict SFR after FURS accurately,and provide assistance for making clinical decisions.