| Objective: To investigate the influencing factors of retrograde intrarenal surgery(RIRS)stone residual,and to evaluate and compare the accuracy of RUSS score and SHA.LIN score in predicting stone clearance rate one month after RIRS.The SHA.LIN scoring system was improved.Methods: Data of patients who underwent retrograde intrarenal surgery for kidney stones in our hospital on January 1,2019 and December 31,2019 were retrospectively studied and collected.A total of 136 cases were included according to the inclusion and exclusion criteria.By retrieving basic information of electronic medical records and obtaining preoperative and postoperative image data,relevant data were summarized and collected.General information: age,sex,height and weight of the patient.Preoperative evaluation: grading by the American Society of Anesthesiologists(ASA),Secondary lithotripsy,previous history(history of lithotripsy,hypertension,diabetes,coronary heart disease),personal history(smoking history,alcohol consumption history),preoperative renal function(creatinine),preoperative uric acid,abnormal inflammatory indicators in blood,abnormal inflammatory indicators in urine,urinary protein,urinary occlusion blood,and preoperative double J catheter indwelling.Calculus and kidney’s general status: isolated kidney,horseshoe kidney,ectopic kidney,staghorn calculi,quantity(multiple stones),stones in the left and right side,stone diameter,density,stones maximum cross-sectional area,IPA,the degree of hydronephrosis,location,stones involving calyces number.Intraoperative evaluation: intraoperative field of vision,operation time,intraoperative blood loss.Postoperative evaluation: the occurrence of complications and the imaging results of reexamination one month after surgery.All patients received retrograde intrarenal surgery by senior physicians with more than 100 cases of retrograde intrarenal surgery experience.The calculative rate of stone clearance depends on the imaging results one month after operation.Patients included in the study were divided into clean group and residual stone group according to the outcome of clear stone one month after surgery for univariate analysis.The normal distribution data was represented by(?)±s,the continuous variables were compared by t-test,the grade data by Mann Whitney U-test and the classified variables by chi-square test.Multivariate Logistic regression was used to analyze the relevant indicators,and the independent risk factors that had a greater impact on the clear stone rate were obtained.The RUSS scoring system and the SHA.LIN scoring system are compared and studied.Receiver operating characteristic curve(ROC curve)of the two scoring systems was plotted.According to the ROC curve,the area under the curve and the 95% confidence interval were calculated to compare the accuracy of the two scoring systems in predicting the stone clearance rate.The SHA.LIN scoring system was modified and compared with the SHA.LIN scoring system based on the independent risk factor results obtained in this study.Results: In this study,stone clearance rate was 43.4% one month after operation,and the incidence of postoperative complications was 13.2%.Single factor analysis found that stone diameter,CT value,stones maximum cross-sectional area,operation time,intraoperative blood loss,abnormal urine inflammation index,antlers,multiple stones,stones anatomical location,involving the calyces number statistically difference in postoperative stone clearance rate.Eight factors including postoperative fever,multiple calculi,IPA,the number of calculi involved in calyces,abnormal inflammatory indicators in urine,stone density,left and right sides,and stone diameter were included in the binary multivariate logistic regression analysis.There were statistical differences in the number of multiple calculi,IPA,the number of calculi involved in calyces,and the side of calculi(P<0.05).Multiple stones,IPA≤45°,stones involving two or more calyces,and stones occurring in the left kidney were the independent risk factors for stone residual after renal calculus RIRS in this study.RUSS scoring system and SHA.LIN scoring system can effectively predict the calculi stone state(p<0.05).The prediction efficiency of SHA.LIN scoring system is slightly higher than that of RUSS scoring system.SHA.LIN.S,the improved scoring system,can effectively predict the state of stone clearing(P<0.05),and has higher predictive efficiency than SHA.LIN.Conclusion: multiple stones,steep IPA,stone involving two or more calyces,occurred in the left kidney is ureteral retrograde intrarenal surgery independent risk factors for postoperative residual stone.Both RUSS score and SHA.LIN score were effective in predicting stone clearance rate after RIRS,and SHA.LIN score was slightly more effective in predicting stone clearance rate than RUSS score.Modified SHA.LIN scoring system-SHA.LIN.S has higher efficiency of prediction. |
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