微创经皮肾镜与传统经皮肾镜治疗肾结石的效果评价

A meta-analysis of traditional percutaneous nephrolithotomy versus mini-percutaneous nephrolithotomy for treatment of kidney calculi

目的评价微创经皮肾镜(PCNL)与传统经皮肾镜治疗肾结石的临床效果及安全性。方法检索Medline、Cochrane Library以及中国期刊全文数据库、中文科技期刊数据库等全文数据库,收集并按照纳入和排除标准筛选关于微创经皮肾镜与传统经皮肾镜治疗肾结石疗效比较的对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率、手术成功率、术中术后出血及输血率的数据进行Meta分析。结果共获得5个符合标准的研究,Meta分析显示微创PCNL在结石清除率、手术成功率方面与传统PCNL无统计学差异[P=0.11,OR=1.11,95%CI:(0.98,1.27);P=0.77,OR=1.02,95%CI:(0.89,1.17)],两种术式治疗肾结石方面所用的手术时间无差异[P=0.06,OR=14.36,95%CI:(-0.7,29.42)]。但在术中及术后出血输血方面,微创PCNL明显优于传统PCNL[P=0.002,OR=0.11,95%CI:(0.03,0.44)]。结论在结石清除率、手术成功率、手术时间方面,微创经皮肾镜与传统经皮肾镜无差别,而术中及术后出血输血方面,微创PCNL明显优于传统PCNL。

Objective To evaluate the efficacy and safety of traditional percutaneous nephrolithotomy versus mini-percutaneous nephrolithotomy for treatment of kidney calculi. Methods Database such as Medline,Cochrane Library and CNKI were systematically searched for controlled studies involved with traditional percutaneous nephrolithotomy versus mini-percutaneous nephrolithotomy for treatment of kidney calcull Eligible studies according to inclusion and exclusion were selected, then index data from included studies were retrieved for a meta-analysis. Results Five studies met the inclusion criteria. The meta-analysis showed no differences between traditional PCNL and mini-PCNE in stone clearance and operation successful rate [P=0.11, OR=1.11, 95%CI：（0.98,1.27）; P=0.77, OR=l.02, 95%CI ：（0.89,1.17）] as well as operation time[P=-0.06, 0R=14.36,95%CI：（-0.7,29.42）]. At the same time, mini-PCNL is better than traditional PCNL in postoperative massive hemorrhage [P=-0.002,0R=0.11, 95%CI：（0.03,0.44）]. Conclusion Mini-PC- NL and traditional PCNL have similar effect in stone clearance, operation successful rate and operation time. At the same time, mini-PCNL is better than traditional PCNL in postoperative massive hemorrhage.