【摘要】：目的:本研究通過(guò)結(jié)合現(xiàn)代影像學(xué)測(cè)得影響微創(chuàng)經(jīng)皮腎鏡取石術(shù)清石率及手術(shù)的參數(shù),并參考現(xiàn)有腎結(jié)石評(píng)分建立G.E.S.S.O.(石膏)腎結(jié)石評(píng)分系統(tǒng),并探討將G.E.S.S.O.評(píng)分應(yīng)用于微創(chuàng)經(jīng)皮腎鏡取石術(shù)(mPCNL)的臨床價(jià)值。方法:基于檢索并學(xué)習(xí)相關(guān)文獻(xiàn)確定變量并建立G.E.S.S.O.評(píng)分系統(tǒng),該評(píng)分納入5個(gè)變量,其中包括G(Guy’s結(jié)石分級(jí))、E(結(jié)石密度)、S(最大累計(jì)橫截面積)、S(體重指數(shù))、0(腎積水程度)。回顧性收集2015年4月至2016年6月收治的142例行微創(chuàng)經(jīng)皮腎鏡取石術(shù)(mPCNL)治療的腎結(jié)石患者的臨床資料。結(jié)合患者術(shù)前泌尿系CTU影像,對(duì)影響結(jié)石清除的變量進(jìn)行測(cè)量。根據(jù)G.E.S.S.O.評(píng)分對(duì)患者術(shù)前結(jié)石進(jìn)行量化分級(jí)和評(píng)分,分析新型G.E.S.S.O.評(píng)分與結(jié)石清除狀態(tài)、手術(shù)時(shí)間、術(shù)中出血量及圍手術(shù)期并發(fā)癥等因素之間的關(guān)系。結(jié)果:(1)本研究共納入142例行mPCNL的腎結(jié)石患者,評(píng)分(7.63±1.977)結(jié)石清除率為69.7%(99/142),41例(28.9%)出現(xiàn)圍手術(shù)期并發(fā)癥。(2)根據(jù)統(tǒng)計(jì)結(jié)果顯示結(jié)石清除組G.E.S.S.O.評(píng)分(6.77±1.276)分,結(jié)石殘留組(9.60±1.892)分,組間對(duì)比差異具有統(tǒng)計(jì)學(xué)意義(t=-8.986,P=0.000),將G.E.S.S.O.評(píng)分劃分為5-7分、8-10分、11-14分三組后結(jié)石清除率分別為91.0%、53.8%、0.0%,其術(shù)前評(píng)分越高,術(shù)后結(jié)石清除率越低。(3)G.E.S.S.O.評(píng)分系統(tǒng)與結(jié)石清除率(P=0.000)、并發(fā)癥發(fā)生率(P=0.006)及手術(shù)時(shí)間(P=0.000)均具有相關(guān)性,但與術(shù)中出血量(P=0.112)、并發(fā)癥的嚴(yán)重程度(P=0.080)不相關(guān)。G.E.S.S.O評(píng)分的受試者工作特征曲線的曲線下面積為0.888[95%CI]。結(jié)論:G.E.S.S.O.腎結(jié)石評(píng)分系統(tǒng)能較準(zhǔn)確的預(yù)測(cè)清石率,具有完善病情評(píng)估的能力,其有助于評(píng)價(jià)腎結(jié)石手術(shù)的復(fù)雜程度,且其與術(shù)后并發(fā)癥發(fā)生具有相關(guān)性,但與術(shù)后并發(fā)癥的嚴(yán)重程度不相關(guān)。
[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 鹵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 鹵1.276) and (9.60 鹵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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R699.2

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