腔内超声造影与常规超声引导经皮肾镜取石术治疗肾结石的Meta分析

Meta-analysis of intracavitary contrast-enhanced ultrasound and conventional ultrasound-guided PCNL for treatment of kidney stones

目的系统评价腔内超声造影(ICCEUS)与常规超声(US)引导经皮肾镜取石术(PCNL)治疗肾结石的临床效果及安全性。方法检索PubMed、Embase、The Cochrane Library、中国知网(CNKI)、维普(VIP)、中国生物医学文献服务系统(SinoMed)和万方(Wanfang Data)等数据库,收集、筛选并提取有关比较ICCEUS与US引导PCNL的临床研究数据。采用RevMan 5.3软件进行Meta分析。结果最终7篇文献被纳入研究,总样本量为696例。ICCEUS-PCNL组一次穿刺成功率(OR=4.52,95%CI:2.99~6.82)和结石清除率(OR=2.32,95%CI:1.15~4.68)均较US-PCNL组高,并发症发生率(OR=0.49,95%CI:0.30~0.80)较US-PCNL组低,血红蛋白下降值(MD=-6.94,95%CI:-9.72~-4.16)和术中出血量(MD=-44.06,95%CI:-73.11~-15.02)较US-PCNL组少,手术时间(MD=-20.86,95CI%:-40.28~-1.44)和住院时间(MD=-2.38,95%CI:-4.15~-0.60)较US-PCNL组短。结论与US-PCNL相比,ICCEUS-PCNL能提高PCNL的一次穿刺成功率及结石清除率,并且可缩短手术时间及住院时间,减少血红蛋白下降值/术中出血量,降低并发症发生率。值得临床推广应用。

Objective To systematically assess the effectiveness and safety of intracavitary contrast-enhanced ultrasound(ICCEUS)and conventional ultrasound(US)-guided PCNL for the treatment of kidney stones.Methods A literature search in PubMed,The Cochrane Library,Embase,CNKI,VIP,SinoMed and Wanfang Data was performed to collect,screen and extract clinical research data comparing contrast-enhanced ultrasound with conventional ultrasound-guided PCNL.Meta-analysis was performed by RevMan 5.3 software.Results 7 literatures were included in this study with a total sample size of 696 cases.ICCEUS-PCNL group had higher success rate of single puncture(OR=4.52,95%CI:2.99~6.82)and stone clearance rate(OR=2.32,95%CI:1.15~4.68)than US-PCNL group.The complication rate(OR=0.49,95%CI:0.30~0.80)was lower than US-PCNL group.The hemoglobin loss value(MD=-6.94,95%CI:-9.72~-4.16)and intraoperative blood loss (MD = -44.06, 95%CI: -73.11 ~ -15.02) were less than US-PCNL group. The operation time (MD = -20.86, 95CI%:-40.28 ~ -1.44) and hospitalization time (MD = -2.38, 95%CI: -4.15 ~ -0.60) were shorter than US-PCNL group.Conclusion Compared with US-PCNL, this Meta-analysis shows that ICCEUS-PCNL can improve the success rateof single puncture and stone clearance rate, shorten the operation time and hospitalization time, and reduce thehemoglobin drop value/intraoperative blood loss and complication rates. It is worthy of clinical application.