Shoaib Mohammad, Bangash Muhibullah, Salam Basit, Ather M Hammad
Surgery, Aga Khan University Hospital, Karachi, PAK.
Radiology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2020 Nov 10;12(11):e11430. doi: 10.7759/cureus.11430.
Objective In this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL). Methods This was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications were graded using the modified Clavien system. Results Of the 142 patients included, 75% were below 55 years of age. More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m. The mean STONE score was 7 with 33% having a high (>9) STONE score. The mean hemoglobin drop was 1.15 +0.92 g/dL with eight patients (5.63%) requiring transfusion and one (0.7%) requiring angioembolization; one patient required readmission for observation. Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients. There was a significant correlation of hemoglobin drop with the STONE score, stone size, and preoperative creatinine clearance. Patients with a hemoglobin drop of >1 g/dL had a higher STONE score and mean stone size. The overall complication rate was significantly higher (10.5%) in patients with a hemoglobin drop of >1 g/dL as compared to those with a hemoglobin drop of <1 g/dL (2.8%). Conclusion Stone complexity as measured by the STONE score correlates with post-PCNL hemoglobin drop, stone clearance, and complication rates. The STONE score may be used for preoperative counseling and to evaluate the potential need for transfusion.
目的 在本研究中，我们旨在确定STONE评分[结石（S）大小、（T）形态或位置、泌尿系统梗阻（O）程度、结石（N）数量以及亨氏单位（E）评估]与接受经皮肾镜取石术（PCNL）患者术后血红蛋白下降之间的相关性。方法 这是一项前瞻性观察性研究，纳入了所有年龄在18 - 65岁、使用26F. 安普茨鞘进行单侧单通道PCNL治疗肾结石的成年患者。在手术前计算STONE肾结石测量评分的五个变量。在术后四周通过影像学评估结石清除率，并使用改良的Clavien系统对并发症进行分级。结果 纳入的142例患者中，75%年龄在55岁以下。超过一半的患者患有糖尿病，超过60%的患者体重指数（BMI）高于25kg/m²。STONE评分的平均值为7分，33%的患者STONE评分较高（>9分）。血红蛋白平均下降1.15 + 0.92g/dL，8例患者（5.63%）需要输血，1例患者（0.7%）需要血管栓塞治疗；1例患者需要再次入院观察。仅通过PCNL就使78.2%的患者实现了结石完全清除。血红蛋白下降与STONE评分、结石大小和术前肌酐清除率之间存在显著相关性。血红蛋白下降>1g/dL的患者STONE评分和平均结石大小更高。血红蛋白下降>1g/dL的患者总体并发症发生率（10.5%）显著高于血红蛋白下降<1g/dL的患者（2.8%）。结论 用STONE评分衡量的结石复杂性与PCNL术后血红蛋白下降、结石清除率和并发症发生率相关。STONE评分可用于术前咨询和评估输血的潜在需求。
