输尿管软镜碎石术与经皮肾镜取石术治疗肾下盏结石患者的Meta分析  

Retrograde intrarenal surgery versus percutaneous nephrolithotomy in treatment of lower pole renal stones:a Meta-analysis

作　　者：张威[1] 彭泳涵[1] 吴腾云[2] 周铁[1] 许传亮[1] 施晓磊[1] 高小峰[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]第二军医大学心理与精神卫生学系基础心理学教研室

出　　处：《临床泌尿外科杂志》2015年第2期141-145,共5页Journal of Clinical Urology

基　　金：上海长海医院1255基金(编号CH125520302);上海市科委医学基金(编号11411950102)

摘　　要：目的:系统评价逆行输尿管软镜碎石术(RIRS)与经皮肾镜取石术(PCNL)治疗肾下盏结石的有效性及安全性,为临床决策提供参考。方法:计算机检索Pubmed、Embase、Web of Science及中国生物医学文献数据库、中国期刊全文数据库、万方数据库等数据库,全面收集有关上述两种手术方式治疗肾下盏结石的随机对照试验和非随机的对照试验,在文献筛选、资料提取和文献质量评价后,采用Stata 12.0软件进行Meta分析。结果:共纳入7个研究,随机对照试验1个,回顾性对照试验6个,共计研究对象595例。Meta分析结果显示:RIRS的结石清除率低于PCNL(OR=0.31;95%CI,0.18~0.54;P<0.01),而在术后住院时间(WMD=-0.85;95%CI,-1.03^-0.67;P<0.01)上则优于PCNL。两种手术方式在术后并发症(OR=0.66;95%CI,0.37~1.17;P=0.16)、平均手术时间(WMD=11.91;95%CI,-3.64~27.46;P=0.13)、辅助治疗率(OR=1.02;95%CI,0.35~3.01;P=0.97)和重复治疗率(OR=1.09;95%CI,0.41~2.89;P=0.86)方面差异无统计学意义。结论:对于肾下盏结石的治疗,PCNL能获得更好的结石清除率,而RIRS能显著缩短住院时间。Objective：To systematically review the efficacy and safety of retrograde intrarenal surgery（RIRS）and percutaneous nephrolithotomy（PCNL）in management of lower pole renal stones.Method：Such databases as PubMed,Embase,Web of Science,CBM,CNKI,and WanFang Data were searched to comprehensively collect the randomized and nonrandomized controlled trials that compared between RIRS and PCNL for treatment of lower pole stones.After the screening of studies,extraction of data,and assessment of methodological quality,a metaanalysis was performed using Stata 12.0software.Result：Seven studies including one randomized controlled trial and six nonrandomized controlled trials were taken,involving 595 patients.The results of the meta-analysis showed that PCNL was better than RIRS in stone-free rate（OR=0.31;95%CI,0.18-0.54;P〈0.01）,but RIRS was superior to PCNL in postoperative hospital stay（WMD=-0.85;95%CI,-1.03--0.67;P〈0.01）.There were no significant differences in postoperative complication rate（OR=0.66;95%CI,0.37-1.17;P =0.16）,operative time（WMD=11.91;95%CI,-3.64-27.46;P =0.13）,auxiliary procedure rate（OR=1.02;9 5%CI,0.35-3.01;P=0.97）,andretreatmentrate（OR=1.09;95%CI,0.41-2.89;P=0.86）betweenthe two treatment techniques.Conclusion：For the treatment of lower pole renal stones,PCNL offers a much higher stone-free rate but a longer postoperative hospital stay than RIRS.

关 键 词：输尿管镜碎石术 经皮肾镜取石术 肾下盏结石 系统评价 META分析 

分 类 号：R692.4[医药卫生—泌尿科学]