经皮肾镜取石术与输尿管软碎石术治疗上尿路结石疗效的Meta分析  

A Meta-analysis of the clinical efficacy of percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in the treatment of upper urinary tract stones

作　　者：鄢羽中[1] 周建辉[1] 苏开德[1] 黄海[1] 刘潜[1] 胡明明[1] 

机构地区：[1]常德市第一人民医院泌尿外科,湖南常德415000

出　　处：《现代泌尿外科杂志》2016年第8期617-622,共6页Journal of Modern Urology

摘　　要：目的综合评价经皮肾镜取石术(PCNL)与经输尿管软镜取石术(FURL)两种方法在治疗上尿路结石上的疗效及安全性,为临床选择手术方式提供参考。方法通过计算机结合手工法检索并选取符合标准的中英文文献,以Meta分析完成数据的整理和分析,疗效评价表示为比值比(OR)、加权均数差(WMD)以及相应的95%置信区间(95%CI),应用漏斗图检测发表偏倚。结果此次Meta分析共纳入符合标准的文献18篇,英文文献10篇,中文文献8篇,共包括2 035例患者,结果显示:PCNL组总的结石清除率高于FURL组[OR=4.03,95%CI(2.65,6.11),P<0.001],PCNL组术中出血量多于FURL组[WMD=2.86,95%CI(0.66,5.07),P<0.05],FURL组住院时间少于PCNL组[WMD=2.45,95%CI(1.39,3.51),P<0.001],两组患者在并发症发生率、手术时间的比较上差异无统计学意义。结论 PCNL治疗肾结石的一期结石清除率较高,FURL创伤小,恢复快,手术并发症和手术时间两组相当。Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy surgery （PCNL） and flexible ureteroscopic lithotripsy （FURL） in the treatment of upper urinary tract stones, in order to provide reference for choosing the proper surgical approach. Methods Published studies in Chinese and English were retrieved and selected by computer com- bined with manual method, then data collected were analyzed with Meta-analysis. Odds ratio （OR）, weighted mean difference （WMD） and corresponding 95% confidence intervals （CI） were used in evaluating the data. Funnel plots were used to detect publication bias. Results A total of 18 studies were selected, including 10 in English and 8 in Chinese, involving 2 035 pa- tients. Meta-analysis showed： the PCNL group had higher stone clearance rate than the FURL group [（OR = 4.03, 95 % CI （2.65, 6.11）,P〈0.001];the PCNL group had more blood loss than the FRUL group [ WMD=2.86, 95%CI（0.66, 5.07）,P 〈0.05];the PCNL group had longer hospital stay than the FURL group [ WMD = 2.45, 95 % CI （1.39, 3.51）, P〈0. 001 ]; there were no significant differences in complications and operation time between the two groups. Conclusions PCNL showed higher efficiency in first-stage stone clearance, while FURL showed less trauma and faster recovery. The two approa- ches had equal complication rate and operation time.

关 键 词：经皮肾镜取石术 经输尿管软镜取石术 肾结石 疗效 

分 类 号：R693.4[医药卫生—泌尿科学]