“骑马射箭”一体位下经皮肾镜联合输尿管软镜治疗复杂性肾结石临床应用的荟萃分析  

Clinical application of percutaneous nephroscope combined with flexible ureteroscopy in"horseback archery"position for complex kidney stones:meta-analysis

作　　者：霍仲超 高一萍 平玉杰[1] 程海峰[1] 王磊[1] 赵雯婷 丁瑞[1] 杨建琪 HUO Zhongchao;GAO Yiping;PING Yujie;CHENG Haifeng;WANG Lei;ZHAO Wenting;DING Rui;YANG Jianqi(Department of Urology,Handan Central Hospital,Hebei,056001,China;Respiratory and Critical Care Medicine WardⅠ,Handan Central Hospital;Operating Room,Handan Central Hospital)

机构地区：[1]河北省邯郸市中心医院泌尿外一科,河北邯郸056001 [2]河北省邯郸市中心医院呼吸与危重症医学科一病区 [3]河北省邯郸市中心医院手术室

出　　处：《临床泌尿外科杂志》2025年第1期58-63,共6页Journal of Clinical Urology

基　　金：国家重点研发计划(No:2021YFC2009300);河北省医学科学研究课题计划(No:20231967)。

摘　　要：目的:利用meta分析的方法评价“骑马射箭”一体位下经皮肾镜联合输尿管软镜治疗复杂性肾结石的临床应用价值。方法:检索2010年1月—2023年12月国内外有关“骑马射箭”一体位下双镜联合治疗复杂性肾结石中的临床研究,按Cochrane系统评价方法提取资料,由2名评价员对纳入文献的质量进行评价,采用Rev-Man5.3统计软件进行统计分析。结果:meta分析最终纳入9篇文献,其中中文7篇,英文2篇,共计907例患者,其中采用“骑马射箭”体位下双镜联合456例,常规俯卧位经皮肾镜451例。结果显示,2组在手术时间(MD=-2.83,95%CI:-8.18~2.51,P=0.30)、术后发热(OR=0.62,95%CI:0.37~1.02,P=0.06)等方面比较差异无统计学意义,但在术后结石清除率(OR=3.77,95%CI:2.66~5.34,P<0.00001)、住院时间(MD=-1.23,95%CI:-2.21~-0.25,P=0.01)、总并发症发生率(OR=0.38,95%CI:0.26~0.56,P<0.00001)、出血量(MD=-47.98,95%CI:-50.86~-45.09,P<0.00001)、血红蛋白下降幅度(MD=-3.47,95%CI:-6.94~-0.01,P=0.05)及输血例数(OR=0.44,95%CI:0.21~0.90,P=0.02)等方面比较差异有统计学意义。结论:与俯卧位经皮肾镜比较,“骑马射箭”一体位下双镜联合治疗复杂性肾结石在结石清除率、住院时间、总并发症发生率、出血量、血红蛋白下降幅度及输血例数等方面具有明显优势,但鉴于纳入文献有限,有待于多中心、高质量的随机对照试验进一步验证。Objective:To evaluate the clinical value of percutaneous nephroscope combined with flexible ureteroscopy in"horseback archery"position for complex kidney stones.Methods:Domestic and foreign clinical studies on percutaneous nephroscope combined with flexible ureteroscopy in"horseback archery"position for complex kidney stones from January 2010 to December 2023 were searched.Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data.The RevMan5.3 software was used for statistical analysis.Results:Eventually 9 articles were enrolled.There were 7 articles in Chinese and 2 in English,with a total of 907 patients.Of these patients,456 cases were treated with the double endoscopies combination in"horseback archery"position,while 451 cases were treated with percutaneous nephroscope in prone position.There was no significant difference in operation time(MD=-2.83,95%CI:-8.18-2.51,P=0.30)or postoperative fever(OR=0.62,95%CI:0.37-1.02,P=0.06)between the two groups,but the postoperative stone clearance rate(OR=3.77,95%CI:2.66-5.34,P<0.000[KG0.5mm]01),hospitalization time(MD=-1.23,95%CI:-2.21--0.25,P=0.01),total complications(OR=0.38,95%CI:0.26-0.56,P<0.000[KG0.5mm]01),blood loss(MD=-47.98,95%CI:-50.86--45.09,P<0.000[KG0.5mm]01),hemoglobin decrease value(MD=-3.47,95%CI:-6.94--0.01,P=0.05)and blood transfusion(OR=0.44,95%CI:0.21-0.90,P=0.02)showed significant difference.Conclusion:The combined treatment in"horseback archery"position for complex kidney stones has obvious advantages in the postoperative stone clearance rate,the total complication rate,blood loss,the number of postoperative blood transfusion cases,and the length of hospital stay.However,additional high-quality,RCTs with larger study populations are needed.

关 键 词：经皮肾镜取石术 软性输尿管镜 斜仰卧截石位 复杂性肾结石 meta分析 

分 类 号：R692.4[医药卫生—泌尿科学]