mPCNL与RPLU治疗输尿管上段嵌顿性结石疗效及安全性的Meta分析

Meta-analysis of the Efficacy and Safety of mPCNL and RPLU in the Treatmentof Upper Ureteral Incarcerated Calculi

目的系统评价微创经皮肾镜碎石术(mPCNL)与经腹膜后腹腔镜输尿管切开取石术(RPLU)治疗输尿管上段嵌顿性结石疗效及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM数据库、WangFang数据库、CNKI数据库和维普数据库,搜集mPCNL与RPLU治疗输尿管上段嵌顿性结石疗效及安全性的随机对照试验(RCT),检索时间为建库至2019年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Review Manager 5.3软件进行Meta分析。结果共纳入9篇RCT,包括2篇英文及7篇中文RCT,共纳入1192例患者。Meta分析显示:RPLU术后3 d结石清除率(RR=0.97,95%CI:0.94~1.00)、术中失血量(MD=39.32,95%CI:5.57~73.08)、术后发热率(RR=2.24,95%CI:1.14~4.41)及术后出血发生率(RR=5.63,95%CI:1.36~23.24)均优于mPCNL,差异有统计学意义(P<0.05);mPCNL与RPLU在手术时间(MD=-5.74,95%CI:-16.90~5.42)、术后继发性输尿管狭窄率(RR=2.76,95%CI:0.69~11.06)方面比较,差异无统计学意义(P>0.05)。结论与mPCNL比较,RPLU为治疗输尿管上段嵌顿结石的一种相对安全、有效的术式,可作为治疗输尿管上段嵌顿结石的优选术式。

Objective To systematically evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy(mPCNL)and retroperitoneal laparoscopic ureterectomy(RPLU)in the treatment of upper ureteral incarcerated calculi.Methods Computer searched PubMed,EMbase,The Cochrane Library,CBM database,WangFang database,CNKI database and Weipu database,and collected randomized controlled trials(RCT)on the efficacy and safety of mPCNL and RPLU in the treatment of upper ureteral incarcerated calculi.The search time was from the establishment of the database to October 2019.After two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies,the Review Manager 5.3 software was used for Meta analysis.Results A total of 9 RCTs were included,including 2 English and 7 Chinese RCTs,and a total of 1192 patients were enrolled.Meta-analysis shows:3 d stone clearance rate after RPLU(RR=0.97,95%CI:0.94~1.00),intraoperative blood loss(MD=39.32,95%CI:5.57~73.08),postoperative fever rate(RR=2.24,95%CI:1.14~4.41)and the incidence of postoperative bleeding(RR=5.63,95%CI:1.36~23.24)was better than mPCNL,the difference was statistically significant(P<0.05);mPCNL and RPLU were in operation time(MD=-5.74,95%CI:-16.90~5.42)and the rate of postoperative secondary ureteral stenosis(RR=2.76,95%CI:0.69-11.06),the difference was not statistically significant(P>0.05).Conclusion Compared with mPCNL,RPLU was a relatively safe and effective procedure for the treatment of upper ureteral incarcerated calculi,and it could be used as the optimal procedure for upper ureteral incarcerated calculi.