经皮肾镜碎石术与经输尿管镜碎石术治疗≥10 mm近端输尿管结石疗效与并发症的meta分析

Meta-analysis of the efficacy and complications of percutaneous nephrolithotripsy versus ureteroscopic lithotripsy for the treatment of≥10 mm proximal ureteral stones

目的采用meta分析经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)与经输尿管镜碎石术(ureteroscopic lithotripsy,URSL)治疗近端输尿管结石(≥10 mm)的有效性、安全性和潜在并发症。方法采用PubMed、Web of Science、Cochrane Library进行系统文献检索,2024年4月前符合条件的比较PCNL与URSL治疗近端输尿管结石的文献均被纳入。采用Review Manager 5.4软件进行统计分析与显著性检验。结果共纳入文献13篇,共涉及患者1102例,PCNL 540例,URSL 562例,其中随机对照试验(randomized controlled trial,RCT)7篇,非RCT 6篇。PCNL手术时间[加权均数差(weighted mean difference,WMD)=20.46,95%CI 1.32~39.60,P=0.04]、总住院时间(WMD=2.31,95%CI 0.57~4.05,P<0.01)、术后住院时间(WMD=2.83,95%CI 1.93~3.73,P<0.01)均长于URSL,初始结石清除率[优势比(odds ratio,OR)=5.50,95%CI 2.04~14.85,P<0.01]和最终结石清除率(OR=5.55,95%CI 3.48~8.87,P<0.01)高于URSL。PCNL与URSL并发症发生率比较,差异无统计学意义(OR=0.96,95%CI 0.62~1.50,P=0.86);PCNL术后发热发生率(OR=1.85,95%CI 1.13~3.04,P=0.02)和输血率(OR=6.90,95%CI1.77~26.89,P<0.01)均高于URSL。结论与URSL比较,PCNL治疗较大的近端输尿管结石更有效,但其危险性较高,具有更高的结石清除率、术后发热率和输血率。

Objective To evaluate the efficacy,safety,and potential complications of percutaneous nephrolithotomy(PCNL)versus ureteroscopic lithotripsy(URSL)for the treatment of≥10 mm proximal ureteral stones by a meta-analysis.Methods Eligible studies comparing PCNL with URSL for proximal ureteral stones through April 2024 were included in a systematic literature search using PubMed,Web of Science,and the Cochrane Library.The Review Manager 5.4 software was used to conduct statistical analyses and significance tests.Results Thirteen articles,including 7 randomized controlled trials(RCTs)and 6 non-RCTs,with a total of 1102 patients(PCNL n=540,URSL n=562)were included.Operative time[weighted mean difference(WMD)=20.46,95%CI 1.32-39.60,P=0.04],total hospitalization time(WMD=2.31,95%CI 0.57-4.05,P<0.01),and postoperative hospitalization time(WMD=2.83,95%CI 1.93-3.73,P<0.01)of PCNL were longer than those of URSL,and initial stone-free rate[odds ratio(OR)=5.50,95%CI 2.04-14.85,P<0.01]and final stone-free rate(OR=5.55,95%CI 3.48-8.87,P<0.01)of PCNL were higher than those of URSL.The complication rates between PCNL and URSL showed no statistically significant difference(OR=0.96,95%CI 0.62-1.50,P=0.86).However,the incidence of postoperative fever(OR=1.85,95%CI 1.13-3.04,P=0.02)and blood transfusion rate(OR=6.90,95%CI 1.77-26.89,P=0.01)in PCNL were higher than those in URSL.Conclusion PCNL is more effective in treating larger proximal ureteral stones than URSL with a higher stone-free rate,but it is more dangerous with a higher postoperative fever and blood transfusion.