输尿管软镜碎石术与经皮肾镜取石术治疗直径<2cm肾结石的有效性和安全性的Meta分析

Efficacy and safety of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy lithotripsy for renal calculus<2cm:aMeta-analysis

目的系统评价输尿管软镜碎石术与经皮肾镜取石术在治疗肾结石(直径<2cm)方面的有效性和安全性。方法计算机检索Pubmed、ScienceDirect、Ovid、Springer、Wiley Online Library、The Cochrane Library、CNKI、CBM、VIP及万方数据库,全面收集有关输尿管软镜碎石术和经皮肾镜取石术比较治疗肾结石的临床对照试验。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,采用RevMan 5.2软件进行Meta分析。结果纳入11篇研究,共计1 060例患者。Meta分析结果显示:输尿管软镜碎石术的清石率低于经皮肾镜取石术[OR=0.44,95%CI(0.29~0.67),P=0.000 1],而在术中出血[MD=-72.78,95%CI(-80.77^-64.79),P<0.000 01]、平均血红蛋白下降量[MD=-0.90,95%CI(-1.41~0.40),P=0.000 5]、是否输血[OR=0.07,95%CI(0.02~0.27),P=0.000 2]等方面则优于经皮肾镜碎石术。结论在结石清除率方面,输尿管软镜取石术低于经皮肾镜取石术,而在手术时间、术中出血量、是否输血等方面,输尿管软镜碎石术则优于经皮肾镜取石术。

Objective To evaluate the efficacy and safety of flexible ureteroscope lithotripsy （FURS） and percutaneous nephrolithotomy lithotripsy （PCNL） for patients with renal calculus （diameter 〈2 cm） .Methods Controlled clinical trials on FURS and PCNL for the treatment of kidney stones were searched in Pubmed ,ScienceDirect ,Ovid ,Springer ,Wiley Online Library ,Cochrane Library ,CNKI ,CBM ,VIP and Wanfang Database .Data collected were screened ,extracted and evaluated by two independent researchers .And then a Meta‐analysis was performed using RevMan 5 .2 software .Results A total of 11 studies were included ,and 1 060 cases were involved .Meta‐analysis showed that PCNL was better than FURS in stone clear‐ance rate [OR= 0 .44 ,95% CI （0 .29 ,0 .67） ,P= 0 .000 1] ,whereas FURS was better than PCNL in bleeding [MD=-72.78 ,95% CI （-80 .77 ,-64 .79） ,P〈0 .000 01] ,the average decline of hemoglobin [MD= -0 .90 ,95% CI （-1 .41 , 0.40） ,P=0 .000 5] ,and blood transfusion [OR=0 .07 ,95% CI （0 .02 ,0 .27） ,P=0 .000 2] .Conclusion PCNL produces higher stone clearance rate than FURS ,while FURS is superior to PCNL in operative time ,blood loss ,and blood transfusion .