开放手术与经皮肾镜取石术治疗鹿角形肾结石的meta分析  

Meta-analysis of open surgery and percutaneous nephrolithotomy in treatment of staghorn calculi

作　　者：徐拥军 刘林[2] 

机构地区：[1]湖北省浠水县团陂镇中心卫生院,438213 [2]武汉大学人民医院

出　　处：《职业与健康》2015年第1期70-73,共4页Occupation and Health

摘　　要：目的探讨开放手术与经皮肾镜取石术治疗鹿角形肾结石的安全性与有效性。方法计算机检索维普、万方、中国知网、Pub Med、Cochrane和EMbase数据库,查找所有比较开放手术和经皮肾镜取石术的随机对照试验(RCT),检索时间范围从2001年1月1日—2013年12月31日,按纳入和排除标准由两人分别独立进行RCT的筛选、提取和质量评价,应用Rev Man5.2进行meta分析。结果共纳入8个研究,共747例患者。Meta分析显示,在手术时间方面,开放手术长于经皮肾镜取石术[WMD=49.77,95%CI(22.47,77.08),P<0.01];在出血量方面,开放手术多于经皮肾镜取石术[WMD=89.81,95%CI(86.20,93.42),P<0.01];在术后住院时间方面,开放手术长于经皮肾镜取石术[WMD=5.34,95%CI(1.81,8.88),P<0.01];在结石清除率方面,开放手术与经皮肾镜取石术相比,差异无统计学意义[OR=0.64,95%CI(0.21,1.99),P>0.05];在并发症发生率方面,开放手术与经皮肾镜取石术相比显著增高[OR=2.13,95%CI(1.33,3.43),P<0.01]。结论两种治疗鹿角性肾结石的手术方法相比,经皮肾镜取石术在手术时间、出血量、术后住院时间和并发症发生率方面均优于开放手术。[Objective]To investigate the efficacy and safety of open surgery and percutaneous nephrolithotomy in treatment of staghorn calculi. [Methods]Chinese science technology journal database（VIP）,Wanfang Database,National Knowledge Infrastructure（CNKI）,Pub Med,Cochrane and EMbase and were searched to collect the randomized controlled trials（RCTs）about the comparison of open surgery and percutaneous nephrolithotomy in treatment of staghorn calculi,which were published between January 1st 2001 and December 31 st 2013. According to the inclusion and exclusion criteria,the collection,assessment and analysis of RCTs were conducted by two reviewers independently,and the Rev Man5.2 software was used to perform Meta-analysis.[Results]Eight RCTs were involved, including 747 patients. Meta-analysis results showed that the operation time of open surgery was longer than that of percutaneous nephrolithotomy[WMD=49.77,95% CI（22.47,77.08）,P〈0.01],the bleeding volume of open surgery was more than that of percutaneous nephrolithotomy[WMD=89.81,95% CI（86.20,93.42）,P〈0.01],and the postoperative hospital stay of open surgery was longer than that of percutaneous nephrolithotomy [WMD =5.34,95% CI（1.81,8.88）,P〈0.01]. However, there was no significant difference in stone clearance rate between two methods[OR=0.64,95% CI（0.21,1.99）,P〉0.05]. The incidence rate of complications of open surgery was higher than that of percutaneous nephrolithotomy [OR =2.13,95% CI（1.33,3.43）,P〈0.01]. [Conclusion]The operation time,bleeding volume,postoperative hospital stay and incidence rate of complications of percutaneous nephrolithotomy are superior to open surgery in treatment of staghorn calculi.

关 键 词：鹿角形肾结石 开放手术 经皮肾镜取石术 META分析 

分 类 号：R181.3[医药卫生—流行病学]