彩超引导下经皮穿刺硬化与腹腔镜去顶减压术治疗单纯性肾囊肿的Meta分析

A Meta-analysis of ultrasound-guided percutaneous puncture sclerotherapy versus laparoscopic decortication in the treatment of simple renal cysts

目的应用Meta分析评价彩超引导下经皮穿刺硬化和腹腔镜去顶减压术治疗单纯性肾囊肿的疗效和安全性。方法检索PubMed、Cochrane Library、中国知网、万方、维普等数据库中有关彩超引导下经皮穿刺硬化和腹腔镜去顶减压术治疗单纯性肾囊肿的前瞻性随机对照试验(RCT),研究结局包括有效率、手术时间、术中出血量、术后住院时间、并发症发生率、复发率、治疗费用。结果共纳入14篇RCT,穿刺硬化组病例726例,去顶减压组750例。Meta分析显示,穿刺硬化组的手术时间[WMD=-41.02,95%CI(-47.41,-34.62),P<0.001]、术后住院时间[WMD=-2.75,95%CI(-3.71,-1.79),P<0.001]、并发症发生率[OR=0.32,95%CI(0.21,0.51),P<0.001]、治疗费用[WMD=-5991.24,95%CI(-6329.46,-5653.02),P<0.001]低于去顶减压组,复发率[OR=16.49,95%CI(4.50,60.48),P<0.001]高于去顶减压组,而有效率[OR=1.40,95%CI(0.91,2.16),P=0.13]、术中出血量[WMD=-9.59,95%CI(-19.34,0.16),P=0.05]的差异无统计学意义。结论在单纯性肾囊肿的治疗中,经皮穿刺硬化相比于腹腔镜去顶减压手术时间短、术后住院时间短、并发症发生率低、治疗费用少,而腹腔镜去顶减压的复发率更低,二者在有效率和术中出血量方面差异无统计学意义。

ObjectiveTo evaluate and compare the efficacy and safety of ultrasound-guided percutaneous puncture sclerotherapy and laparoscopic decortication in the treatment of simple renal cyst. MethodsProspective randomized controlled trials (RCTs) comparing ultrasound-guided percutaneous puncture sclerotherapy and laparoscopic decortication treating simple renal cyst were searched in databases of PubMed,Cochrane Library,CNKI,WANFANG and VIP.The effective rate,operation time,intraoperative blood loss,postoperative hospital stay,complication rate,recurrence rate and medical costs were analyzed. ResultsA total of 14 RCTs were included,with 726 cases involved in the puncture sclerotherapy group and 750 in the decortication group. Meta -analysis revealed that the puncture sclerotherapy group had shorter operation time[WMD =-41.02,95% CI (-47.41,-34.62), P<0.001],shorter postoperative hospital stay[WMD =-2.75,95% CI (-3.71,-1.79), P<0.001],lower complication rate[OR =0.32,95% CI (0.21,0.51), P<0.001],and lower medical costs[WMD =-5 991.24,95% CI (-6 329.46 ,-5 653.02), P<0.001]than the decortication group,but higher recurrence rate[OR =16.49,95% CI (4.50,60.48), P<0.001].There were no significant statistical significances in the effective rate[ OR =1.40,95% CI (0.91,2.16), P =0.13] and intraoperative blood loss[ WMD =-9.59,95% CI (-19.34,0.16), P =0.05]. ConclusionIn the treatment of simple renal cyst,compared with laparoscopic decortication,percutaneous puncture sclerotherapy has advantages of shorter operation time and postoperative hospital stay,lower complications rate and medical costs,but higher recurrence rate.There are no statistical differences between them in the effective rate and intraoperative blood loss.