摘要
目的:系统评价经皮肾镜取石术(PCNL)与输尿管软镜碎石术(RIRS)治疗肾结石的有效性及安全性,为临床选择提供依据。方法:制定检索策略后分别检索PubMed、Embase、Cochrane Library、中国知网、万方、维普数据库,全面收集有关上述两种手术方式治疗肾结石的随机对照研究(RCT),检索年限为建库至2016年5月,制定纳入和排除标准并据此筛选文献,资料提取后利用Revman 5.3软件进行Meta分析。结果:共纳入6篇文献的6项相互独立的随机对照研究,共计389例患者,其中PCNL组195例,RIRS组194例。Meta分析结果显示,PCNL的结石清除率大于RIRS(OR=2.48,95%CI 1.3~4.73,P=0.006),按照结石大小不同进行亚组分析,>2cm的肾结石PCNL的结石清除率大于RIRS(OR=4.53,95%CI 1.81~11.3,P=0.001),而<2cm的肾结石两者间差异无统计学意义(OR=2.78,95%CI 0.71~10.94,P=0.14);而在血红蛋白下降值方面,RIRS优于PCNL(MD=0.51,95%CI 0.17~0.85,P=0.004);另外,手术并发症(OR=2.0,95%CI 0.89~4.47,P=0.09)、术后住院时间(MD=0.74,95%CI-0.09~1.56,P=0.08)、平均手术时间(MD=0.24,95%CI-10.48~10.96,P=0.97)及重复治疗率(OR=0.85,95%CI 0.30~2.42,P=0.76)上,两者差异无统计学意义。结论:对于肾结石治疗,PCNL有更好的结石清除率(尤其是对于>2cm的肾结石);而RIRS治疗肾结石失血量更少。
Objective： To provide a systematic review and meta-analysis of studies comparing between PCNL and RIRS for the safety and efficacy in the treatment of kidney stones. Method： All randomized controlled trails （RCTs） comparing between PCNL and RIRS for treatment of kidney stones, published from the date of database building to May 2016 were retrieved from PubMed, Embase, Coehrane Library, CNKI, WanFang and VIP data- base. Meta-analysis was performed by collecting information in the included studies through Revman 5.3. Result： Six RCTs involving 389 patients （PCNL 195 and RIRS 194） were included. The result of the meta-analysis showed that PCNL was better than RIRS in stone-free rate （OR=2.48, 95%CI 1.3-4.73, P=0.006）, and in subgroup analysis according to different stone size a similar advantage was observed with stone-free rate of the PC- NL for renal calculus （〉2 cm） （OR=4.53, 95%CI 1.81 11.3, P=0.001）. However, there was no significant difference in stone-free rate for renal calculus （〈2 cm） （OR=2.78, 95%CI 0.71-10.94, P=0. 14）. RIRS was superior to PCNL inAHb （MD=0.51, 95%CI 0.17 0.85, P=0.004）. Also, there were no significant differ- ence in complication rate （OR= 2.0, 95 % CI 0.89-4.47, P = 0.09）, postoperative hospital stay （MD= 0.74, 95%CI -0.09-1.56, P=0.08）, operative time （MD=0.24, 95%CI -10.48-10.96, P=0.97） and retreatment rate （OR= 0. 85, 95 %CI 0.30-2.42, P= 0.76） between the two treatment techniques. Conclusion： For the treatment of renal stone especially larger than 2 cm, PCNL offers a much higher stone-free rate but a more blood loss than RIRS.
出处
《临床泌尿外科杂志》
2017年第5期365-369,共5页
Journal of Clinical Urology
关键词
经皮肾镜取石术
输尿管软镜碎石术
肾结石
随机对照研究
META分析
pereutaneous nephrolithotomy
retrograde intrarenal surgery
renal stones
randomized con- trolled trials
meta-analysis
