目的:系统评价输尿管软镜(flexible ureteroscopic surgery,fURS)碎石术中粉末化碎石与碎块化碎石2种碎石方式之间的有效性与安全性.方法:计算机检索PubMed、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方和维普数据库中关于比较fURS粉末化与碎块化碎石的对照研究,试验组为粉末化碎石,对照组为碎块化碎石,检索时限均从建库至2024年2月.由2名研究人员提取资料,并进行质量评价.采用Revman 5.3软件进行meta分析.结果:最终共纳入13篇文献,研究对象1 774例,其中试验组835例,对照组939例.meta分析结果显示,试验组短期及长期结石清除率低于对照组[OR=o.53,95％CI:0.40～0.70,P＜0.000 01;OR=0.53,95％CI:0.32～0.90,P=0.02];试验组手术时间短于对照组[MD=-10.89,95％CI:-17.56～-4.22,P=0.001];试验组与对照组住院时间、术后发热率、总体并发症发生率、额外干预措施需要率比较,均差异无统计学意义[MD=-0.14,95％CI:-0.14～0.06,P=0.42;OR=0.85,95％CI:0.48～1.49,P=0.57;OR=1.02,95％CI:0.70～1.49,P=0.90;OR=0.97,95％CI:0.63～1.49,P=0.88].敏感性分析结果显示,合并结果稳定可靠.结论:现有文献证据表明fURS碎石碎块化较粉末化手术时间长,但碎块化较粉末化碎石短期及长期结石清除率高,两者都具有较高安全性.同时仍需更多大样本、高质量的研究进一步证实结论.
Meta-analysis of the effectiveness and safety of"pulverization"and"fragmentation"lithotripsy in flexible ureteroscopic surgery
Objective:To systematically evaluate the effectiveness and safety of pulverization and fragmenta-tion in fURS lithotripsy.Methods:We searched for controlled studies comparing between pulverization and frag-mentation in fURS lithotripsy in PubMed,Web of Science,Cochrane Library,SinoMed,CNKI,Wanfang Data,and VIP Database.The experimental group was pulverization and the control group was fragmentation.The search time was from the establishment of the database to February,2024.Two researchers extracted the data and evaluated the quality.Meta-analysis was performed using Revman 5.3 software.Results:Finally,13 articles were included,with a total of 1 774 subjects,including 835 in the experimental group and 939 in the control group.The results of the meta-analysis showed that the short-term and long-term stone clearance rates in the experimental group were lower than those in the control group[OR=0.53,95％CI:0.40-0.70,P＜0.000 01;OR=0.53,95％CI:0.32-0.90,P=0.02];The operation time in the experimental group was shorter than that in the con-trol group[MD=-10.89,95％CI:-17.56--4.22,P=0.001];However,there was no significant difference in hospital stay,postoperative fever rate,overall complication rate,or need for additional interventions between the experimental group and the control group[MD=-0.14,95％CI:-0.14-0.06,P=0.42;OR=0.85,95％CI:0.48-1.49,P=0.57;OR=1.02,95％CI:0.70-1.49,P=0.90;OR=0.97,95％CI:0.63-1.49,P=0.88].The results of sensitivity analysis showed that the combined results were stable and reliable.Conclusion:Existing evidence suggests that the operation time of fragmentation in fURS lithotripsy is longer than that of pulverization,but the short-term and long-term stone clearance rates of fragmentation are higher than those of pulverization.Both methods have high safety.However,more large-scale and high-quality studies are needed to further confirm these findings.
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