逆行肾内手术与经皮肾镜取石术治疗2~3 cm肾结石的meta分析

Meta analysis of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of 2-3 cm renal calculi

目的系统评价逆行肾内手术(RIRS)与经皮肾镜取石术(PCNL)治疗2~3 cm肾结石的疗效及安全性。方法检索PubMed、EMBASE、Science、万方、维普以及中国知网数据库,以确定符合条件的对比研究。检索时限均从建库至2019年10月。采用RevMan 5.3软件进行meta分析。结果纳入10项研究,共1597例患者,其中RIRS组778例,PCNL组819例。Meta分析结果显示:与PCNL比较,RIRS的无石率较低[OR=0.47,95%CI(0.34,0.66),P<0.00001],住院时间更短[MD=-2.45,95%CI(-2.96,-1.94),P<0.00001]、血红蛋白减少量更少[MD=-6.43,95%CI(-9.05,-3.82),P<0.00001]、并发症发生率更低[OR=0.69,95%CI(0.51,0.93),P=0.02],但两者的手术时间无明显差异[MD=6.27,95%CI(-3.51,16.05),P=0.21]。结论与PCNL比较,RIRS具有稍低的无石率,但其在住院时间、血红蛋白减少量和并发症发生率方面具有显著优势。因此,RIRS是PCNL治疗2~3 cm肾结石的安全、有效的替代方案。

Objective To systematically review the efficacy and safety of retrograde intrarenal surgery(RIRS)versus percutaneous nephrolithotomy(PCNL)in kidney stones of 2-3 cm.Methods PubMed,EMBASE,Science,WanFang,VIP and CNKI databases were electronically searched to identify all eligible comparative studies from inception of the database to October 2019.Then meta-analysis was performed by using RevMan 5.3 software.Results A total of 10 studies involving 1597 patients were included.Among them,there were 778 patients in the RIRS group and 819 patients in the PCNL group.The results of meta-analysis showed that:compared with PCNL,RIRS had lower stone-free rate(OR=0.47,95%CI[0.34,0.66],P<0.00001),shorter hospital stay(MD=-2.45,95%CI[-2.96,-1.94],P<0.00001),less decrease in haemoglobin(MD=-6.43,95%CI[-9.05,-3.82],P<0.00001),and lower complication rate(OR=0.69,95%CI[0.51,0.93],P=0.02),but no difference was found in operation time between the two groups(MD=6.27,95%CI[-3.51,16.05],P=0.21).Conclusion Compared with PCNL,RIRS has a lower SFR,but it has advantages in terms of hospital stay,decrease in haemoglobin,and complication rate.Therefore,for patients with kidney stones of 2-3 cm,RIRS is a safe and effective alternative to PCNL.