微创与标准经皮肾镜取石术比较的荟萃分析

Meta-analysis of minimally invasive percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy

目的:系统评价微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)具有的优势。方法:搜集国内外有关微创与标准经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)的随机对照试验(randomized controlled trial,RCT)文献,并追查已纳入文献的参考文献,对符合纳入标准的研究使用统计软件RevMan 5.0完成Meta分析。结果:经筛选最后纳入5篇文献资料进行Meta分析,共726例,与试验组比较,对照组患者:①结石清除率明显提高(95%CI[1.00-1.21],P=0.04);②并发症发生率显著降低(95%CI[0.40-0.79],P=0.000 9)。结论:现有证据证明,MPCNL在结石清除率和并发症发生率方面较标准PCNL具有明显优势。本文因纳入文献和样本量有限,建议进行大样本、长期随访的高质量临床试验,为MPCNL的临床应用提供更佳的循证依据。

Objective：To systematically review the advantages of minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods ： Randomized controlled trials of minimally invasive and standard percutaneous nephrolithotomy were retrieved and their included references were investigated. Data analysis of literatures meeting the inclusion criteria was performed with the Coehrane Collabora tion＇ s RevMan 5.0 software. Results ： Five literatures were finally retrieved after screening and a total of 726 patients were included for Meta-analysis. Results showed that the patients in experimental group had the following features as compared with those in control group： ①remarkable improvement of the calculi clearance rate（95%Cl[1.OO-1.21],P=O.O4）;②obvious decrease of the complication incidence （95%C1[0.40-0.79],P=0.000 9）. Conclusions ： With higher clearance rate,lower complication incidence, MPCNL is safer and more effective than standard percutaneous nephrolithotomy in treating upper urinary tract calculi. As the literatures and samples in this study are limited,high quality trials with lager sample and longer follow-up are recommended in order to provide reliable evidences for clinical application of MPCNL.