fURL与mPCNL治疗孤立肾结石安全性和有效性的Meta分析  

Meta-analysis of safety and efficacy of fURL and mPCNL in the treatment of solitary kidney stones

作　　者：吴冠伟 付永 许海斌[1] 谷明利[1] 宁晶 关超[1] WU Guanwei;FU Yong;XU Haibin;GU Mingli;NING Jing;GUAN Chao(Department of Urology,Second Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui,233040,China)

机构地区：[1]蚌埠医学院第二附属医院泌尿外科,安徽蚌埠233040

出　　处：《临床泌尿外科杂志》2020年第7期532-538,共7页Journal of Clinical Urology

基　　金：蚌埠医学院自然科学基金面上项目(No:BYKY18144)。

摘　　要：目的:系统评价经输尿管软镜碎石术(fURL)与微通道经皮肾镜取石术(mPCNL)治疗孤立肾结石的临床效果及安全性。方法:通过计算机检索CBM、CNKI、VIP、WANFANG database、Pubmed、EMBASE、Science Direct和Cochrane Library,全面搜集有关fURL和mPCNL治疗孤立肾结石效果的临床研究。由两位研究者独立进行文献筛选、资料提取和质量评价,利用RevMan 5.35软件进行Meta分析。结果:共纳入10篇临床研究,其中3篇为随机对照研究,余7篇均为非随机对照研究,共计851例患者。Meta分析结果显示:fURL在治疗孤立肾结石的手术时间[MD=10.68,95%CI(5.35,16.01),P<0.000 1]和>20 mm结石清除率[OR=0.24,95%CI(0.13,0.45),P<0.000 01]劣于mPCNL,但在术后血红蛋白丢失量[MD=-3.28,95%CI(-4.06,-2.50),P<0.000 01]、术后出血发生率[OR=0.30,95%CI(0.12,0.74),P=0.009]和住院时间[MD=-3.53,95%CI(-4.26,-2.79),P<0.000 01]方面优于mPCNL。结论:fURL与mPCNL均为孤立肾结石的可选术式,对于体积较小的孤立肾结石应优先考虑应用fURL,而当结石负荷大时应考虑应用mPCNL。Objective: To systematically evaluate the clinical efficacy and safety of flexible ureteroscope lithotripsy(fURL) and microchannel percutaneous nephrolithotomy(mPCNL) in the treatment of solitary kidney stones. Method: Clinical studies on fURL and mPCNL in the treatment of isolated kidney stones were collected by computer retrieval of CBM, CNKI, VIP, WANFANG database, Pubmed, EMBASE, Science Direct and Cochrane Library. Literature screening, data extraction and quality evaluation were performed independently by two researchers, and Meta-analysis was performed using RevMan 5.35 software. Result: A total of 10 clinical studies were included, of which 3 were randomized controlled studies, and the remaining 7 were non-randomized controlled studies, with a total of 851 patients. The results of Meta-analysis showed that the operative time of fURL in the treatment of isolated kidney stones [MD=10.68, 95%CI(5.35, 16.01), P<0.000 1]and >20 mm stone clearance [OR=0.24, 95%CI(0.13, 0.45), P<0.000 01]were inferior to mPCNL, but the amount of postoperative hemoglobin loss after surgery [MD=-3.28, 95%CI(-4.06,-2.50), P<0.000 01], postoperative bleeding rate [OR=0.30, 95%CI(0.12, 0.74), P=0.009]and hospitalization time [MD=-3.53, 95%CI(-4.26,-2.79), P<0.000 01]were superior to mPCNL. Conclusion: Both fURL and mPCNL are optional for isolated kidney stones. FURL should be preferred for smaller size isolated kidney stones, while mPCNL should be considered for large stone load.

关 键 词：肾结石 输尿管镜 经皮肾镜 孤立肾 手术 

分 类 号：R692.4[医药卫生—泌尿科学]