Stone Unit, Guy's and St. Thomas' National Health Services Foundation Hospital, London, United Kingdom.
Urology. 2011 Aug;78(2):277-81. doi: 10.1016/j.urology.2010.12.026. Epub 2011 Feb 17.
To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL.
The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis.
The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P = .01). It was found to be reproducible, with good inter-rater agreement (P = .81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate.
The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible.
报告一种评分系统——盖斯结石评分的制定和验证，以对经皮肾镜碎石术（PCNL）的复杂性进行分级。目前，尚无预测 PCNL 后结石清除率的标准化方法。
盖斯结石评分通过专家意见、已发表数据回顾和迭代测试相结合制定。它包括 4 个等级：I 级，肾盂或中下盏的单个结石或简单解剖结构的单个结石；II 级，上盏的单个结石或简单解剖结构的多个结石或解剖结构异常的单个结石；III 级，解剖结构异常的多个结石或在盏憩室或部分鹿角结石中的结石；IV 级，鹿角结石或在脊柱裂或脊髓损伤患者中的任何结石。使用 Kappa 系数评估其可重复性，并在三级结石中心进行的 100 例 PCNL 前瞻性数据库中进行验证。使用改良 Clavien 评分对并发症进行分级。临床结果前瞻性记录，并进行多变量分析评估。
盖斯结石评分是唯一显著且独立预测结石清除率的因素（P =.01）。它具有可重复性，组内一致性良好（P =.81）。测试的其他因素，包括结石负荷、手术医生、患者体重、年龄和合并症，均与结石清除率无关。
盖斯结石评分可准确预测 PCNL 后的结石清除率。它易于使用且具有可重复性。
