经皮肾镜取石术与输尿管镜碎石术治疗直径>1cm的嵌顿性输尿管上段结石的Meta分析

A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm

目的系统评价经皮肾镜取石术(PCNL)与输尿管镜碎石术(URL)治疗直径>1 cm的嵌顿性输尿管上段结石的有效性及安全性。方法计算机检索Pub Med、Cochrane图书馆、Embase、万方、中国知网全文数据库、维普数据库(从建库至2015年7月),纳入PCNL与URL治疗直径>1 cm的嵌顿性输尿管上段结石的随机对照试验(RCT),对纳入的研究进行质量评价,并提取有效数据,采用Rev Man 5.3软件进行Meta分析。结果最终纳入6篇文献,均为RCT,患者共487例。Meta分析结果表明,与URL组比较,PCNL组患者结石清除率提高[RR=1.20,95%CI(1.09,1.33),P=0.000 3],术后发热、输尿管穿孔发生率差异无统计学意义[RR=1.73,95%CI(0.43,7.00),P=0.45;RR=1.02,95%CI(0.11,9.37),P=0.99],术后显著血尿发生率更高[RR=1.99,95%CI(1.09,3.62),P=0.03],平均手术时间更长[WMD=30.03 min,95%CI(10.04,50.02)min,P=0.003],平均住院时间延长3.73 d[WMD=3.73 d,95%CI(3.02,4.44)d,P<0.000 01]。结论 PCNL能明显提高直径>1 cm的嵌顿性输尿管上段结石清除率,但平均手术时间及患者平均住院时间更长。

Objective To assess the efficacy and safety of percutaneous nephrolithotomy （PCNL） versus ureteroscopic lithotripsy （URL） in the treatment of impacted proximal ureteral stones 〉1 cm. Methods We electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database （by the end of July 2015） to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones 〉 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. Results Six randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group （URL）, the patients in the trial group （PCNL） had the following features： （1） There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI （1.09, 1.33）, P=0.00 03]. （2） There was no statistica/difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI （0.43, 7.00）, P=0.45; RR=I.02, 95%CI （0.11, 9.37）, P=0.99], but the incidence of hematuria was higher [RR=l.99, 95%CI （1.09, 3.62）, P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI （10.04, 50.02） minuntes, P=0.003]. （3） The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI （3.02, 4.44） days, P 〈 0.000 01]. Conclusion PCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.