Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
World J Urol. 2017 Aug;35(8):1241-1246. doi: 10.1007/s00345-016-1990-4. Epub 2016 Dec 24.
To compare the intraoperative surgeon perspective for detection of residual fragments (RFs) after percutaneous nephrolithotomy (PNL) with postoperative NCCT.
A prospective study of adult patients who underwent PNL between March and September 2014 was conducted. Stone complexity was evaluated using the Guy's stone score (GSS). All patients were evaluated by pre- and postoperative NCCT. After the procedure, the surgeon had been asked whether there were residual stones or not. The sensitivity, specificity and predictive values were tested against postoperative NCCT. Predictors of accurate intraoperative assessment were determined using univariate and multivariate statistical analyses.
The study included 306 consecutive patients. The surgeons reported no residual stones in 236 procedures; of whom 170 (72%) were reported stone-free by NCCT. On the other hand, 65 out of 70 procedures (93%) reported with residual stones by the surgeons were true by NCCT. The sensitivity was 50% and the NPV was 72%, while the specificity was 97% and the PPV was 93%. On multivariate analysis, only lower GSS (p < 0.001) was independently associated with true negative surgeon opinion.
Although there was a high surgeon ability to detect post-PNL residual stones, postoperative imaging is mandatory because of the high false negative rates and low NPV. The surgeon opinions can be judged only in stones with lower GSS. The NPV could be enhanced if a consistent definition of clinically significant RFs is introduced.
比较经皮肾镜碎石取石术（PNL）后，术者术中对残留结石碎片（RFs）的检出与术后 NCCT 的效果。
对 2014 年 3 月至 9 月期间接受 PNL 的成年患者进行前瞻性研究。采用 Guy 结石评分（GSS）评估结石复杂性。所有患者均行术前和术后 NCCT 检查。术后，术者被问及是否有残留结石。以术后 NCCT 为金标准，检测灵敏度、特异度和预测值。采用单变量和多变量统计分析确定术中准确评估的预测因素。
该研究共纳入 306 例连续患者。236 例手术中，术者报告无残留结石，其中 170 例（72%）经 NCCT 证实为无结石。另一方面，65 例手术中术者报告有残留结石，经 NCCT 证实均为阳性。灵敏度为 50%，NPV 为 72%，特异度为 97%，PPV 为 93%。多变量分析显示，只有较低的 GSS（p<0.001）与术者的阴性预测值相关。
尽管术者检测 PNL 后残留结石的能力较高，但由于假阴性率高、NPV 低，术后影像学检查仍然是必要的。只有在结石 GSS 较低时，才能对术者的意见进行判断。如果引入一致的有临床意义的 RFs 定义，则可提高 NPV。
