经输尿管软镜取石术与经皮肾镜取石术对肾结石治疗方面相关疗效比较的Meta分析

发布时间：2019-05-30 03:00

【摘要】：目的：综合评价经输尿管软镜取石术（FURL)与经皮肾镜取石术(PCNL)在肾结石治疗方面的安全性、疗效。通过结石清除率、手术时间、住院时间、手术并发症等方面的分析，从而对临床上肾结石的治疗起到一定的指导作用。 方法：计算机检索：Pubmed，CNKI，ScienceDirect，Ovid，维普数据库，CBMdisc，万方医学网，Medline，Springer等相关的数据库，手工检索已经发表的运用经输尿管软镜取石术（flexible ureteroscope lithtripsy），经皮肾镜取石术（percutaneous nephrolithotomy）治疗肾结石的国内外文献，并追查相关纳入文献的参考文献，使用Revman5.2软件完成相关手术指标的Meta分析，采用比值比（OR值），加权均数差（WMD）和95%置信区间（95%CI）进行疗效的评价，运用egger检测发表偏倚，应用敏感性分析分析结论的稳定性，最后对分析结果进行整理并发表。 结果：检索后，共有11篇符合标准的文献纳入此次Meta分析，中文2篇，英文9篇，共1095例患者，方法学质量均为B级。Meta分析结果显示：经输尿管软镜取石术组的总的结石清除率未达到经皮肾镜取石术组的疗效。OR值等于0.64,95%置信区间为（0.44，0.94），P=0.02。在≤2cm的结石清除率方面经输尿管软镜取石术组低于经皮肾镜取石术组OR值等于0.64，95%的置信区间为（0.42，0.98），P=0.01。而在＞2cm的结石清除率方面差异则无统计学意义OR值等于0.51，95%置信区间为（0.17,1.50），P=0.22。经皮肾镜取石术组在手术时间上优于经输尿管软镜取石术组，加权均数差等于17.06，95%的置信区间为（2.94，31.18），P=0.02。经输尿管软镜取石术组在住院时间上优于经皮肾镜取石术组，标准化均数差为-1.29，95%置信区间为(-1.71，-0.87)，P＜0.00001。手术总并发症发生率OR值0.47，95%的置信区间（0.30，0.73），P=0.0008。输血率OR值0.14，95%的置信区间（0.03，0.63），P=0.01。经输尿管软镜取石术组与经皮肾镜取石术组发热差异无统计学意义OR值1.19，95%的置信区间（0.53，2.70），P=0.68。经输尿管软镜取石术与经皮肾镜取石术出血率差异无统计学意义OR值0.35，，95%的置信区间（0.09，1.42），P=0.29，总之，经输尿管软镜取石术组在手术并发症方面优于经皮肾镜取石术组。 结论： 两种手术方式对肾结石治疗方面相关疗效比较分析结论如下： 1.经输尿管软镜取石术在处理肾结石时安全可靠，但总的结石清除率却没有取得经皮肾镜取石术的疗效。 ①处理≤2cm的肾结石时，经输尿管软镜取石术的疗效较低； ②处理＞2cm的肾结石时，经输尿管软镜取石术与经皮肾镜取石术两者疗效相当。 2.在手术时间上，经皮肾镜取石术用时短。 3.在住院时间、住院花费、手术并发症上，经输尿管软镜取石术占有较大优势。
[Abstract]:Objective: to evaluate the safety and efficacy of (FURL) and (PCNL) in the treatment of renal calculi. Through the analysis of stone clearance rate, operation time, hospitalization time, surgical complications and so on, it can play a certain guiding role in the treatment of renal stones. Methods: computer retrieval: Pubmed,CNKI,ScienceDirect,Ovid, Weipu database, CBMdisc, Wafang medical network, Medline,Springer and other related databases, manual retrieval of published use of soft ureter lithotomy (flexible ureteroscope lithtripsy), The domestic and foreign literature of (percutaneous nephrolithotomy) in the treatment of renal calculi was carried out, and the references included in the literature were traced down. The Meta analysis of the relevant surgical indexes was completed by Revman5.2 software, and the ratio (OR value) was used. Weighted mean difference (WMD) and 95% confidence interval (95%CI) were used to evaluate the curative effect. Egger was used to detect the bias, and the stability of sensitivity analysis was used. Finally, the analysis results were sorted out and published. Results: after retrieval, a total of 11 articles were included in the Meta analysis, 2 in Chinese and 9 in English, with a total of 1095 patients. The results of meta-analysis showed that the total stone clearance rate of the group was not as good as that of the group. The OR value was equal to 0.64, and the 95% confidence interval was (0.44, 0.94), P 鈮

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