经皮肾镜取石术与输尿管镜碎石术治疗上段嵌顿性输尿管结石患者的Meta分析

Meta-analysis of PCNL versus URL in treatment of impacted upper ureteral calculi

目的：评价经皮肾镜取石术（PCNL）与输尿管镜碎石术（URL）治疗上段嵌顿性输尿管结石患者的有效性及安全性，为临床的合理治疗提供参考。方法：计算机检索Cochrane图书馆（2013年第6期）、Medline、EMBASE、WebofKnowledge、ScienceDirect、OVID及CBM、CNKI、万方等数据库，收集上述两种手术方式对上段输尿管嵌顿性结石患者的随机对照和非随机对照试验，并提取相关数据后采用RevMan5.1软件进行Meta分析。结果：总共纳入7项研究，随机对照试验4项，非随机对照试验3项。随机对照试验中PCNL较URL患者术后3日内结石清除率高（OR=14.78；95%CI 6.60-33.09）、二次手术率低（OR=0.13；95%CI 0.03-0.66）、术后住院时间长（OR=3.51；95%CI 2.05-4.98），但术后发热情况差异无统计学意义（P＞0.05）；非随机对照试验中PCNL较URL的术后3日内结石清除率高（OR=21.63；95%CI 3.92-119.30）、二次手术率低（OR=0.05；95%CI 0.01-0.25）、术后住院时间长（OR=2.85；95%CI 2.40-3.31），术后血尿更多见（OR=2.37；95%CI 1.16-4.85），但术后发热情况差异无统计学意义（P＞0.05）。结论：PCNL治疗上段嵌顿性输尿管结石患者较URL效果更理想。

Objective： To evaluate the efficacy and safety of percutaneous nephrolithotomy （PCNL） and ureteroscopic lithotripsy （URL） in treatment of impacted upper ureteral calculi so as to provide reference for clinical reasonable treatment. Method： The electronic databases including Cochrane library （Issue 6, 2013）, Medline, EMBASE, Web of Knowledge, ScienceDirect, OVID, CBM, CNKI and WANFANG were searched, and the randomized and nonrandomized controlled trials about the two kinds of operation method for ureteral impacted stones were collected. Then we analyzed the extracted relevant data with the help of RevMan 5. 1 software. Result： Seven studies including four randomized controlled trials and three nonrandomized controlled trials were taken. The results were shown as follows. PCNL was found higher stone-free rate at three days postoperatively （ORal4.78; 95% CI 6.60-33.09）, lower re-operation rate （OR=0.13; 95% CI 0.03-0.66） and longer postoperative hospital stay （OR= 3.51; 95 %CI 2.05-4.98） than URL in the randomized controlled trials. However, the difference of incidence of postoperative fever was not significant （P〉0.05）. In the nonrandomized controlled trials PCNL was associated with higher stone-free rate at three days postoperatively （OR： 21.63; 95 % CI 3.92-119.30）, lower re-operation rate （OR： 0.05; 95%CI 0. 01-0. 25）, longer postoperative hospital stay （OR=2.85; 95%CI 2. 40-3. 31）, more postoperativehematuria （OR：2.37; 95%CI 1.16-4.85）. Nevertheless, the difference of incidence of postoperative fever showed no statistical significant （P〉0.05）. Conclusion： PCNL is superior to URL in treatment of impacted upper ureteral calculi.