经皮肾镜取石术和输尿管软镜碎石术治疗孤立肾结石有效性和安全性的Meta分析
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摘要
目的系统评价经皮肾镜取石术(PCNL)和输尿管软镜碎石术(RIRS)治疗孤立肾结石的安全性及有效性。方法利用计算机及手工检索万方、维普、知网数据库以获取相关中文文献;检索PubMed,Web of Knowledge数据库获以取相关英文文献。检索日期为2010年6月～2017年6月,中文检索词包括"输尿管软镜、经皮肾镜、孤立肾"等。其后,进行文献筛选、资料提取和质量评价等,并将所获文献中的数据按手术方法分为PCNL组和RIRS组。结果 PCNL组结石清除率高于RIRS组(P <0.000 01,OR=2.54,95%CI:1.80～3.58),手术时间短于RIRS组(P <0.0001,MD=-21.69,95%CI:-31.85～-11.53);RIRS组手术出血量少于PCNL组(P=0.03,MD=76.28,95%CI:5.99～146.56),住院时间少于PCNL组(P=0.0003,MD=2.41, 95%CI:1.09～3.74),发生输血风险也低于PCNL组(P=0.02,OR=6.37,95%CI:1.42～28.52);两组在总体并发症方面差异无统计学意义(P> 0.05)。结论孤立肾结石治疗方法的选择可以通过平衡手术的优缺点并结合患者的实际情况来综合评判。
Objective To systematically evaluate the efficacy and safety of percutaneous nephrolithotomy surgery(PCNL) and retrograde intrarenal surgery(RIRS) in the patients with solitary kidney calculi. Methods Wanfang, VIP and CNKI databases were retrieved by computer and hand to obtain relevant Chinese documents, and PubMed and Web of Knowledge databases were retrieved to obtain relevant English documents. The search date is June 2010 to June 2017.The Chinese search terms include "flexible ureteroscope, percutaneous nephroscopy, isolated kidney" and so on. Subsequently, literature screening, data extraction and quality evaluation were carried out, the data in the relevant document obtained were divided into PCNL group and RIRS group. Results The stone clearance rate in PCNL group was higher than that in RIRS group(P < 0.00001, OR = 2.54, 95% CI: 1.80-3.58), the operation time was shorter than that in RIRS group(P < 0.0001, MD =-21.69, 95%CI:-31.85--11.53), the bleeding volume in RIRS group was less than that in PCNL group(P = 0.03, MD = 76.28, 95%CI: 5.99-146.56), the hospitalization time was shorter than that in PCNL group(P = 0.0003, MD = 2.41, 95%CI: 1.09-3.74), and the risk of transfusion was also lower than that of the PCNL group(P = 0.02,OR = 6.37, 95%CI: 1.42-28.52); there was no significant difference in the overall complications between the two groups. Conclusion The choice of treatment method for solitary kidney calculi can be judged by balancing the advantages and disadvantages of surgery and combining the actual situation of patients.
Objective To systematically evaluate the efficacy and safety of percutaneous nephrolithotomy surgery(PCNL) and retrograde intrarenal surgery(RIRS) in the patients with solitary kidney calculi. Methods Wanfang, VIP and CNKI databases were retrieved by computer and hand to obtain relevant Chinese documents, and PubMed and Web of Knowledge databases were retrieved to obtain relevant English documents. The search date is June 2010 to June 2017.The Chinese search terms include "flexible ureteroscope, percutaneous nephroscopy, isolated kidney" and so on. Subsequently, literature screening, data extraction and quality evaluation were carried out, the data in the relevant document obtained were divided into PCNL group and RIRS group. Results The stone clearance rate in PCNL group was higher than that in RIRS group(P < 0.00001, OR = 2.54, 95% CI: 1.80-3.58), the operation time was shorter than that in RIRS group(P < 0.0001, MD =-21.69, 95%CI:-31.85--11.53), the bleeding volume in RIRS group was less than that in PCNL group(P = 0.03, MD = 76.28, 95%CI: 5.99-146.56), the hospitalization time was shorter than that in PCNL group(P = 0.0003, MD = 2.41, 95%CI: 1.09-3.74), and the risk of transfusion was also lower than that of the PCNL group(P = 0.02,OR = 6.37, 95%CI: 1.42-28.52); there was no significant difference in the overall complications between the two groups. Conclusion The choice of treatment method for solitary kidney calculi can be judged by balancing the advantages and disadvantages of surgery and combining the actual situation of patients.
引文
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[13]罗庆华,曹雷华,湛辉鹏,等.经皮肾镜及输尿管软镜治疗>2 cm孤立肾结石的临床疗效比较[J].江西医药,2016(1):12-14.
[14]郑铎,田彦.输尿管软镜联合钬激光碎石术治疗孤立肾结石的临床观察[J].中国卫生标准管理,2016,7(36):62-63.
[15]郭一泓,李毅宁,张建育,等.经皮肾镜取石术与输尿管软镜碎石术治疗孤立肾结石对比分析[J].中外医学研究,2016,14(27):30-31.
[16]钱冲,刘成倍,周泽光,等.电子输尿管软镜钬激光碎石治疗孤立肾结石的临床观察[J].微创泌尿外科杂志,2015,4(6):341-343.
[17]王进峰,吴志坚.孤立肾肾结石的治疗现状[J].医学综述,2007,13(4):292-294.
[18]杨春生,梁磊,孟繁林,等.输尿管软镜碎石术与微创经皮肾镜碎石术治疗孤立肾结石对比观察[J].山东医药,2015,55(19):48-50.
[19]巴达仁贵,姜海山.B超引导下标准通道经皮肾镜取石术联合超声气压弹道碎石术治疗上尿路结石疗效研究[J].中国医学装备,2017,14(12):78-81.
[20]陈亮,李建兴.经皮肾镜碎石取石术的并发症的防治[J].现代泌尿外科杂志,2013,18(6):527-531.
[21]宋飞,曹栋威,赵谦,等.B超引导下经皮肾镜联合碎石、清石系统治疗复杂性肾结石[J].现代泌尿外科杂志,2006,11(6):341-343.
[22]张宇,姜有涛,李九智,等.微通道经皮肾镜碎石与输尿管软镜碎石治疗孤立肾肾下盏2~3 cm结石的比较[J].中国医药导报,2018,15(6):58-62.
[23]赵明,胡忠春,张文才.经皮肾镜下超声气压弹道碎石机与钬激光碎石机在复杂性肾结石治疗中的应用研究[J].中国医学装备,2017,14(4):102-105.
[24]张志宏,金石华,黄华刚,等.输尿管软镜碎石术后并发脓毒症的临床分析[J].中国医药导报,2017,14(24):85-87.
[2]吴猛,刘良兵,易东风.软性输尿管镜钬激光碎石术与经皮肾镜碎石取石术治疗直径≤2 cm肾结石5年回顾性分析[J].临床外科杂志,2017,25(6):469-471.
[3]杨嗣星,宋超,刘凌琪,等.输尿管镜下钬激光碎石与经皮肾镜取石术治疗肾结石的疗效比较[J].中华泌尿外科杂志,2013,34(9):666-669.
[4]徐鑫,蒋召强,刁统祥,等.经皮肾镜取石术与输尿管软镜碎石术治疗肾结石的Meta分析[J].临床泌尿外科杂志,2017(5):365-369.
[5]Knoll T,Jessen JP,Honeck P,et al.Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size[J].World J Urol,2011,29(6):755-759.
[6]Bai Y,Wang X,Yang Y,et al.Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney:a single centre experience[J].BMC Urol,2017,17(1):9.
[7]冯勇,陈文章,毛会峰,等.经皮肾镜碎石取石术与输尿管软镜碎石术治疗孤立肾肾结石的临床特点及疗效分析[J].临床医学研究与实践,2017,2(2):1-3.
[8]刘斌,董杰,周水根,等.经皮肾镜及输尿管软镜治疗孤立肾肾盂结石的临床疗效及对肾功能影响的比较[J].中国微创外科杂志,2014,14(5):430-433.
[9]杨华旭.输尿管软镜碎石术与微创经皮肾镜碎石术治疗孤立肾结石的临床效果比较[J].临床合理用药杂志,2016,9(26):126-127.
[10]林海利,郑周达,杨明根,等.经皮肾镜与输尿管软镜在孤立肾结石的应用比较[J].中国微创外科杂志,2016,16(4):301-303.
[11]梁磊,杨春生,孟繁林,等.孤立肾结石的两种微创治疗方法比较[J].实用医学杂志,2015,31(15):2535-2538.
[12]曾双喜,刘建文,袁小丁.经皮肾镜治疗孤立肾肾盂结石的临床效果及对肾功能的影响分析[J].世界最新医学信息文摘:连续型电子期刊,2014(25):123-123.
[13]罗庆华,曹雷华,湛辉鹏,等.经皮肾镜及输尿管软镜治疗>2 cm孤立肾结石的临床疗效比较[J].江西医药,2016(1):12-14.
[14]郑铎,田彦.输尿管软镜联合钬激光碎石术治疗孤立肾结石的临床观察[J].中国卫生标准管理,2016,7(36):62-63.
[15]郭一泓,李毅宁,张建育,等.经皮肾镜取石术与输尿管软镜碎石术治疗孤立肾结石对比分析[J].中外医学研究,2016,14(27):30-31.
[16]钱冲,刘成倍,周泽光,等.电子输尿管软镜钬激光碎石治疗孤立肾结石的临床观察[J].微创泌尿外科杂志,2015,4(6):341-343.
[17]王进峰,吴志坚.孤立肾肾结石的治疗现状[J].医学综述,2007,13(4):292-294.
[18]杨春生,梁磊,孟繁林,等.输尿管软镜碎石术与微创经皮肾镜碎石术治疗孤立肾结石对比观察[J].山东医药,2015,55(19):48-50.
[19]巴达仁贵,姜海山.B超引导下标准通道经皮肾镜取石术联合超声气压弹道碎石术治疗上尿路结石疗效研究[J].中国医学装备,2017,14(12):78-81.
[20]陈亮,李建兴.经皮肾镜碎石取石术的并发症的防治[J].现代泌尿外科杂志,2013,18(6):527-531.
[21]宋飞,曹栋威,赵谦,等.B超引导下经皮肾镜联合碎石、清石系统治疗复杂性肾结石[J].现代泌尿外科杂志,2006,11(6):341-343.
[22]张宇,姜有涛,李九智,等.微通道经皮肾镜碎石与输尿管软镜碎石治疗孤立肾肾下盏2~3 cm结石的比较[J].中国医药导报,2018,15(6):58-62.
[23]赵明,胡忠春,张文才.经皮肾镜下超声气压弹道碎石机与钬激光碎石机在复杂性肾结石治疗中的应用研究[J].中国医学装备,2017,14(4):102-105.
[24]张志宏,金石华,黄华刚,等.输尿管软镜碎石术后并发脓毒症的临床分析[J].中国医药导报,2017,14(24):85-87.