微创经皮肾镜碎石术中钬激光与气压弹道治疗肾结石疗效的Meta分析

发布时间：2018-03-28 17:01

  本文选题：肾结石　切入点：钬激光　出处：《山西医科大学》2014年硕士论文

【摘要】：目的 应用Meta分析方法比较钬激光碎石术(Holmium laser lithotripsy, HL)与气压弹道碎石术(Pneumatic lithotripsy, PL)两种碎石术在微创经皮肾镜碎石术(Minimally invasive percutaneous nephrolithotomy lithotripsy, MPCNL)中治疗肾结石的优缺点,评估两种碎石术的安全性和有效性,为经皮肾镜碎石术治疗肾结石提供临床治疗证据,为临床医师在手术方式的选择上提供可靠的循证学证据。 方法 计算机检索Pubmed、Cochrane library、SpringerLink、Embase、中国知网、维普数据库、万方医学等中英文数据库,搜集关于微创经皮肾镜碎石术中HL与PL治疗肾结石的随机对照研究。检索时间范围设定为从建库至2013年10月31日。两名研究者对符合纳入标准的文献数据进行独立提取。试验采用Cochrane协作网推荐的偏倚风险评价工具进行评价。纳入数据通过RevMan5.0软件进行Meta分析。观察指标包括：1)碎石手术时间；2)工期治疗结石排净率；3)Ⅱ期治疗结石排净率；4)临床并发症；5)术中出血量；6)术后住院时间；7)结石排净时间。 结果 按照严格的文献纳入标准,最终纳入临床随机对照研究的文献共有7篇,总共纳入870例患者,钬激光碎石术组437例,气压弹道碎石术组433例。Meta分析结果示： (1)碎石手术时间的比较：经RevMan5.0软件统计分析合并数据后得TotalWMD=-13.79,95%CI (-18.06,-9.51), Z=6.32, P=0.00001,两组在碎石手术时间方面的差异有统计学意义,微创经皮肾镜碎石术中HL组的碎石手术时间比PL组短。 (2)Ⅰ期治疗结石排净率的比较：经RevMan5.0软件统计分析合并数据后得RR=1.13,95%CI(1.05,1.22), Z=3.15, P=0.002,两组的Ⅰ期治疗结石排净率有统计学意义,微创经皮肾镜碎石术中HL组较PL组Ⅰ期治疗结石排净率高。 (3)Ⅱ期治疗结石排净率的比较：经RevMan5.0软件统计分析合并数据后得RR=1.11,95%CI(0.98,1.26), Z=1.70, P=0.09,两组的Ⅱ期治疗结石排净率有统计学意义,微创经皮肾镜碎石术中HL组较PL组Ⅱ期治疗结石排净率高。 (4)临床并发症发生率的比较：经RevMan5.0软件统计分析合并数据后得RR=-0.41,95%CI (0.22,0.73), Z=3.00,P=0.003,两组在临床并发症发生率方面的差异有统计学意义,微创经皮肾镜碎石术中HL组的临床并发症发生率比PL组低。 (5)术中出血量的比较：经RevMan5.0软件统计分析合并数据后得TotalWMD=-24.41,95%CI (-26.2,-22.55), Z=25.72, P0.00001,两组术中出血量方面的差异有统计学意义,微创经皮肾镜碎石术中HL组的术中出血量比PL组少。 (6)术后住院时间的比较：经RevMan5.0软件统计分析合并数据后得TotalWMD=-2.14,95%CI (-2.64,-1.64), Z=8.40, P 0.00001,两组术后住院时间的差异有统计学意义,微创经皮肾镜碎石术中HL组的术后住院时间比PL组短。 (7)结石排净时间的比较：经RevMan5.0软件统计分析合并数据后得TotalWMD=-11.00,95%CI-12.28,-9.72), Z=16.85, P0.00001,两组结石排净时间的差异有统计学意义,微创经皮肾镜碎石术中HL组的结石排净时间比PL组短。 结论 通过Meta分析表明两种碎石术在微创经皮肾镜碎石术中治疗肾结石相比较有以下特点： 1、钬激光碎石术的碎石手术时间较气压弹道碎石术的碎石手术时间短。 2、钬激光碎石术较气压弹道碎石术Ⅰ、Ⅱ期治疗结石排净率高。 3、钬激光碎石术的结石排净时间比气压弹道碎石术组短。 4、钬激光碎石术的术中出血量较气压弹道碎石术少。 5、钬激光碎石术的临床并发症发生率比气压弹道碎石术组低。 6、钬激光碎石术的术后住院时间比气压弹道碎石术组短。
[Abstract]:objective
Application of Meta analysis method comparison of holmium laser lithotripsy (Holmium laser lithotripsy, HL) and pneumatic lithotripsy (Pneumatic lithotripsy PL) two lithotripsy in minimally invasive percutaneous nephrolithotomy (Minimally invasive percutaneous nephrolithotomy lithotripsy, MPCNL) the advantages and disadvantages in the treatment of renal calculi and to evaluate the safety and efficacy of lithotripsy for two. Percutaneous nephrolithotomy in treatment of renal calculi provide clinical evidence for clinicians to provide reliable evidence-based medicine in the choice of surgical approach.
Method
Computer retrieval Pubmed, Cochrane library, SpringerLink, Embase, Chinese CNKI, VIP database, Wanfang database and English, collecting randomized controlled study of HL and PL percutaneous nephrolithotomy in treatment of renal calculi by minimally invasive. The retrieval time range is set from the database to October 31, 2013. Two researchers independently to extract in accordance with the inclusion criteria of literature data. In this experiment, the Cochrane collaboration bias risk assessment tool to evaluate. Included in the Meta data were analyzed by RevMan5.0 analysis software. The observation indexes include: 1) gravel operation time; 2) the duration of treatment of stone clearance rate; 3) phase II treatment of stone clearance rate; 4) clinical complications 5); bleeding; 6) hospitalization time after operation; 7) the lithagogue time.
Result
A total of 7 articles were included in the randomized controlled clinical trials, including 870 patients, 437 holmium laser lithotripsy group and 433 pneumatic ballistic lithotripsy group. The results of.Meta analysis showed that:
(1) comparison: gravel operation time is analyzed by RevMan5.0 software with data of TotalWMD=-13.79,95%CI (-18.06, -9.51), Z=6.32, P=0.00001, there was significant difference in the operation time of the two groups of gravel, gravel operation time of HL group after minimally invasive percutaneous nephrolithotomy in shorter than the PL group.
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