逆行输尿管软镜碎石术、经皮肾镜与体外冲击波碎石对肾下盏结石有效性和安全性的Meta分析  

Meta analysis of the efficacy and safety of retrograde intrarenal surgery,percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in treatment of lower pole renal stone

作　　者：徐巧萍[1] 高峰[2] 虞旗旗[2] 黄亚胜[2] XU Qiaoping;GAO Feng;YU Qiqi;HUANG Yasheng(Department of Clinical Pharmacology,Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院临床药理研究室,310006 [2]杭州市中医院泌尿外科

出　　处：《浙江医学》2022年第18期1971-1977,1999,共8页Zhejiang Medical Journal

摘　　要：目的评价逆行输尿管软镜碎石术(RIRS)、经皮肾镜碎石取石术(PCNL)和体外冲击波碎石术(ESWL)治疗肾下盏结石的有效性及安全性。方法通过计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、维普及万方等数据库,收集2020年12月前上述3种方式治疗肾下盏结石的随机对照试验或回顾性病例对照试验,严格按照纳入与排除标准对文献进行筛选、数据提取和质量评价,采用Revman 5.3软件进行Meta分析。结果共纳入16项研究,共计2784例肾下盏结石患者。Meta分析结果显示,ESWL术后结石清除率明显低于RIRS和PCNL(OR=0.46,95%CI:0.34~0.63,P<0.05;OR=0.33,95%CI:0.26~0.43,P<0.05)。ESWL术后并发症发生率明显低于PCNL(OR=0.21,95%CI:0.15~0.29,P<0.05);但ESWL与RIRS术后并发症发生率比较差异无统计学意义(OR=0.74,95%CI:0.50~1.09,P>0.05)。ESWL术后再次治疗率明显高于RIRS和PCNL(OR=14.03,95%CI:8.79~22.39,P<0.05;OR=20.62,95%CI:12.87~33.05,P<0.05)。结论与PCNL、RIRS相比,ESWL在治疗肾下盏结石中有效性较低,表现为结石清除率低、再次治疗率高,术后并发症发生率比PCNL高。Objective To systematically review the efficacy and safety of retrograde intrarenal surgery(RIRS),percutaneous nephrolithotomy(PCNL)and extracorporeal shock wave lithotripsy(ESWL)in the treatment of lower pole renal stone(<3 cm).Methods Databases PubMed,Embase,the Cochrane library,and Web of Science were searched for randomized controlled trials and non-randomized controlled trials of RIRS,PCNL and ESWL in treatment of lower pole renal stone before 2020.After data extraction and literature quality evaluation,a meta analysis was performed using Revman 5.3software.Results A total of 16 studies were included,8 randomized controlled trials and 8 retrospective case-control trials involving 2784 patients.Meta-analysis results showed that the stone clearance rate of ESWL was significantly lower than that of PCNL and RIRS(OR=0.33,95%CI:0.26-0.43,P<0.05;OR=0.46,95%CI:0.34-0.63,P<0.05).Postoperative complication rate of ESWL was significantly lower than that of PCNL(OR=0.21,95%CI:0.15-0.29,P<0.05),but no significant difference between ESWL and RIRS(OR=0.74,95%CI:0.50-1.09,P>0.05).ESWL has a significantly higher re-treatment rate than PCNL and RIRS(OR=20.62,95%CI:12.87-33.05,P<0.05;OR=14.03,95%CI:8.79-22.39,P<0.05).Conclusion Compared with PCNL and RIRS,ESWL is less effective in the treatment of lower calyx stones,which is manifested by lower stone clearance rate,higher re-treatment rate,and higher incidence of postoperative complications than PCNL.

关 键 词：输尿管软镜碎石术 经皮肾镜碎石取石术 体外冲击波碎石术 META分析 肾下盏结石 

分 类 号：R699.2[医药卫生—泌尿科学]