输尿管镜术治疗输尿管上段结石有效性和安全性的Meta分析

Effectiveness and Safety of Ureteroscopy Surgery in Treatment of Upper Ureteral Calculi: A Meta-Analysis

目的系统评价经尿道输尿管镜碎石术治疗输尿管上段结石的安全性和有效性。方法计算机检索TheCochraneLibrary（2013年第3期）、PubMed（1966～2013．8）、EMbase（1990～2013．8）、CNKI（1949-2013．9）、CBM（1978～2013．9）、VIP（1989-2013．8）和WanFangData（1990～2013．8），全面收集有关后腹腔镜输尿管切开取石术和经尿道输尿管镜碎石术比较治疗输尿管上段结石的随机对照试验（RCT）。由2位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量后，采用RevMan5．2软件进行Meta分析。结果共纳入16个RCT，1410例患者，其中输尿管镜组747例，后腹腔镜组663例。Meta分析结果显示：输尿管镜组在手术成功率[OR=0．26，95％CI（O．14，O．51）]、3天结石清除率[OR=0．06，95％CI（0．03，0．11）]和1月结石清除率[OR=0．21，95％CI（0．08，0．53）]方面均低于后腹腔镜组，但在手术时间[MD=-22．35，95％CI（-35．29，-9．41）]、术后住院时间[MD=-1．84，95％CI（-3．44，-0．24）]方面优于后腹腔镜组。结论现有证据表明：对于输尿管上段结石，经尿道输尿管镜碎石术比后腹腔镜输尿管切开取石术手术时间及术后住院时间更短，但在手术成功率、清石率及并发症发生率等方面并无优势。

Objective To systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. Methods We electronically searched The Cochrane Library （Issue 3, 2013）, PubMed （1966 to 2013.8）, EMbase （1990 to 2013.8）, CNKI （1949 to 2013.9）, CBM （1978 to 2013.9）, VIP （1989 to 2013.8） and WanFang Data （1 990 to 2013.8） for the randomized controlled studies （RCTs） related to retroperitoneoscopy uretero- lithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 16 RCTs involving 1 410 patients （transurethral ureteroscopy lithotripsy： 747 cases; etroperitoneal laparoscopic ureterolithotomy： 663 cases） were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of sur- gery （OR=0.26, 95%CI 0.14 to 0.51）, 3-day stone clearance rates （OR=0.06, 95%CI 0.03 to 0.11）, and 1-month stone clear- ance rates （OR=0.21, 95%CI 0.08 to 0.53）, while it showed superiority in operation time （MD= -22.35, 95%CI -35.29 to -9.41） and postoperative hospital stay （MD= -1.84, 95%CI-3.44 to -0.24）. Conclusion Current evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1 -month stone clearance rates.