后腹腔镜肾盂成形术与传统开放肾盂成形术治疗UPJO的meta分析

Meta- analysis of Retroperitoneoscopic Pyeloplasty and Traditional Open Pyeloplasty in Treatment of Congenital Ureteropelvic Junction Obstruction

目的利用"meta分析探讨后腹腔镜肾盂成形术与传统开放肾盂成形术治疗肾盂输尿管连接部梗阻的安全性和有效性。方法计算机检索Pub Med、Cochrane、EMbase、中国知网、万方和维普数据库,查找所有比较后腹腔镜肾盂成形术与传统开放肾盂成形术治疗肾盂输尿管连接部梗阻的随机对照试验,检索时限均为2005年1月1日到2015年8月1日,同时手检纳入文献的参考文献,按纳入排除标准由2人独立进行随机临床试验(RCT)的筛选、资料提取和质量评价后,采用Rev Man 5.3软件进行Meta分析。结果共纳入10个研究,共801例患者。Meta分析结果显示,在手术时间和复发率方面,后腹腔镜肾盂成形术与传统开放肾盂成形术无统计学意义(P>0.05)。与传统开放肾盂成形术相比,后腹腔镜肾盂成形术的术中出血量少(95%CI-84.46^-51.3,P<0.000 01),术后住院时间短,(95%CI-5.64^-4.05,P<0.00001),并发症较少(OR=0.37,P=0.007)。结论后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻与传统开放肾盂成形术安全性相似,但创伤更小,术后恢复更快,有更少并发症,值得推荐。

Objective To investigate the safety and efficacy of retroperitoneoscopic pyeloplasty and traditional open pyeloplasty in the treatment of congenital ureteropelvic junction obstruction. Methods The literature databases PubMed, Cochrane Library, EM- base, CNKI, WANFANG and VIP were searched for randomized controlled trials （RCTs） on retroperitoneoscopic pyeloplasty and tra- ditional open pyeloplasty in the treatment of congenital ureteropelvic junction obstruction from January 1 st 2005 to August 1 st 2015. After manual search for reference documentation classified into literature and the selection, data extraction, assessment of the RCTs which were undertaken by 2 reviewers independently according to inclusion and exclusion criteria, meta - analysis was conducted with the RevMan 5. 3 software. Results Ten studies involving 801 patients met the inclusion criteria. Meta - analysis results showed that there was no statistically significant difference in the operative time and the recurrence rate between the retroperitoneoscopic pyeloplasty and traditional open pyeloplasty （P 〉 0.05 ）. Compared with traditional open pyeloplasty, the patients with retroperitoneoscopic pyeloplasty had less blood loss （95% CI - 84.46 ~ - 51.3, P 〈 0. 000 O1 ）, shorter postoperative hospitalization length （ 95% CI - 5.64 - - 4. 05, P 〈 0. 000 01 ）, and fewer postoperative complications （ OR = 0. 37, P = 0. 007）. Conclusion Retroperitoneoscopic pyelo- plasty shares similar safety in the treatment of congenital ureteropelvic junction obstruction with traditional open pyeloplasty, but with the advantages of smaller trauma, faster recovery and fewer complications, which is worth of recommendation.