| Objectives: At present,there is no widely accepted preoperative scoring model for retrograde intrarenal surgery.This study analyzed the influencing factors of postoperative stone clearance rate and postoperative complication rate of retrograde intrarenal surgery,comparing the predictive value of S-Re SC score and SHA.LIN score,improving the predictive power of SHA.LIN score.Exploring the prediction value of S-Re SC score and SHA.LIN score for the occurrence of serious postoperative complications.Methods: A total of 269 patients who done retrograde intrarenal surgery in the Second Ward of Urology Department,The Second Affiliated Hospital of Kunming Medical University from May 2019 to May 2021 were retrospectively analyzed,and the admittance standard was strictly implemented.The collected information included general data,preoperative data,stone related data,and postoperative data.According to whether the stone was cleared or not,the patients were divided into the residual stone group and the clean group for univariate analysis.The statistically significant data were included in multivariate Logistic regression analysis and independent risk factors were obtained.The ROC curve of each scoring rule of S-Re SC score and SHA.LIN score were drawn,The ROC curve of final total score was drawn,Combined with Logistic regression analysis results and clinical practice,SHA.LIN score was improved and named SHA.LDN score,The three scoring system of ROC curve performance two contrast,Delong inspection,Getting the difference in efficacy.According to the Clavien-Dindo Grading of complications,the patients were divided into three groups: no special complication group(Clavien grade Ⅰ and no complication patients),mild complication group(Clavien grade Ⅱ)and severe complication group(Clavien grade Ⅲ and above).Univariate analysis was performed to obtain the related influencing factors of complications.With the occurrence of severe complications as the outcome index,ROC curves of three scoring systems were drawn to evaluate their effectiveness in predicting postoperative severe complications.Results: Unifactorial analysis of 269 cases showed that there were statistically significant differences between the residual stone group and the clean group in stone size,average stone density,previous history of lithotripsy,IPA,multiple stone,stone location,number of calices involved,degree of hydronephrosis,urinary white blood cells,urinary bacteria,hypertension and diabetes(p < 0.05).Combined with clinical practice and reference of relevant literature,8 factors including stone size,average stone density,IPA,multiple stones,stone location,number of involved calices,degree of hydronephrosis,and previous history of lithotripsy were incorporated into binary and multi-factor Logistic regression,and it was concluded that stone size,IPA,multiple stones,and stone location(p < 0.05)were independent risk factors in this study.According to the results of binary Logistic regression analysis and the actual clinical situation,the SHA.LIN score was improved,removing the stone density item,and adding whether the stone was multiple,and named the improved SHA.LDN score.The SHA.LIN score,S-Re SC score and modified SHA.LDN score all had good predictive effect on stone clearance rate,with AUC of 0.853,0.829 and 0.884,respectively.Results of pairwise comparison of scoring models: The prediction efficiency of improved SHA.LDN score was better than that of SHA.LIN score(p=0.046,<0.05)and S-Re SC score(p=0.004,<0.05),but there was no significant difference between SHA.LIN score and S-Rs SC score(p= 0.263,>0.05).The patients were divided into three groups according to the Clavien-Dindo Grading of complications;there were statistically significant differences in gender,hypertension,previous history of lithotripsis,abnormal renal function,urinary white blood cells,urinary bacteria,operation time,Length of stay,SHA.LIN score,S-Re SC score and modified SHA.LDN score(p < 0.05).The SHA.LIN score,S-Re SC score,and modified SHA.LDN score had good predictive efficacy for severe postoperative complications,with AUC of 0.868,0.788,and 0.854,respectively.Conclusions: 1.Stone size,IPA,multiple stones and stone location are independent risk factors related to postoperative stone clearance.2.SHA.LIN score,S-Re SC score and modified SHA.LDN score all have good predictive efficacy of stone clearance,and the modified SHA.LDN score is better than the other two scoring models.3.SHA.LIN score,S-Re SC score and modified SHA.LDN score all had certain predictive efficacy on the occurrence of postoperative severe complications,and there was no significant difference among them... |
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