输尿管软镜、经皮肾镜与体外冲击波碎石术治疗肾下盏结石的Meta分析

目的 系统评价输尿管软镜碎石术(RIRS)、经皮肾镜碎石术(PCNL)与体外冲击波碎石术(ESWL)治疗肾下盏结石(<3 cm)的有效性及安全性.方法 检索Pubmed、Embase、Web of Science等数据库,收集2020年9月前RIRS、PCNL、ESWL三种手术治疗肾下盏结石的随机对照研究和队列研究,在文献筛选、资料提取和文献质量评价后,采用Revman 5.3软件进行Meta分析.结果 共纳入16个研究、随机对照研究8个、回顾性队列研究8个,研究对象共2784例.ESWL结石清除率明显低于PCNL和RIRS[(OR 0.03,95%CI 0.26~0.43,P<0.05),(OR 0.46,95%CI 0.34~0.63,P<0.05)],PCNL清石率、术后并发症与RIRS差异无统计学意义[(OR 0.75,95%CI 0.52~1.07,P>0.05)、(OR 1.28,95%CI 0.86~1.89,P>0.05)],ESWL术后并发症明显低于PCNL和RIRS[(OR 0.21,95%CI 0.15~0.29,P<0.05),(OR 0.74,95%CI 0.50~1.09,P<0.05)].重复治疗率:ESWL明显高于PCNL及RIRS[(OR 20.62,95%CI 12.87~33.05,P<0.05),(OR 14.03,95%CI 8.79~22.39,P<0.05)],PCNL与RIRS差异无统计学意义(OR=0.53,95%CI,0.21~1.32,P>0.05).结论 肾下盏结石的治疗ESWL清石率不及PCNL、RIRS,其术后重复治疗率高于PCNL及RIRS.RIRS与PCNL在结石清除率、并发症及重复治疗率方面相似.

Objective To systematically review the fficacy and safety of retrograde ureteroscopic lithotripsy(RIRS),percutaneous nephrolithotomy(PCNL)and extracorporeal shock wave lithotripsy(ESWL)in the treatment of lower pole renal stone(smaller than 3 cm).Methods Search for databases such as Pubmed,Embase,and Web of Science,and collect randomized controlled trials and non-randomized controlled trials of the above three methods for the treatment of lower pole renal stone before September 2020.The RevMan 5.3 was used for this meta-analysis after literature screening,data extraction and literature quality evaluation.Results A total of 16 studies were included,8 randomized controlled trials and 8 retrospective case-control trials,involving 2784 patients.Meta-analysis results showed that the stone clearance rate of ESWL was significantly lower than that of PCNL and RIRS(OR 0.03,95%CI 0.26~0.43,P<0.05),(OR 0.46,95%CI 0.34~0.63,P<0.05),but no significant difference between PCNL stone clearing rate and RIRS(OR 0.75,95%CI 0.52~1.07,P>0.05).There were no significant differences in postoperative complications between the PCNL and RIRS groups(OR 1.28,95%CI,0.86~1.89,P>0.05).ESWL was significantly lower than PCNL and RIRS(OR 0.21,95%CI 0.15~0.29,P<0.05),(OR 0.74,95%CI 0.50~1.09,P<0.05).ESWL had a significantly higher retreatment rate than PCNL and RIRS(OR 20.62,95%CI,12.87~33.05,P<0.05),(OR 14.03,95%CI 8.79~22.39,P<0.05),but there was no significant difference between PCNL and RIRS(OR 0.53.95%CI 0.21~1.32,P>0.05).Conclusion For the treatment of lower pole renal stone,the clearance rate of ESWL is lower than that of PCNL and RIRS,and its re-treatment rate is higher than PCNL and RIRS.There is no significant difference between RIRS and PCNL in terms of clearance rate,complications,and retreatment rate.