经皮肾镜碎石术与经输尿管镜碎石术治疗≥10 mm近端输尿管结石疗效与并发症的meta分析
Meta-analysis of the efficacy and complications of percutaneous nephrolithotripsy versus ureteroscopic lithotripsy for the treatment of ≥10 mm proximal ureteral stones
王贵林 1景锁世 1骆作喜 1姬鲁华 1陈传健 1王志平 1李笑然1
作者信息
- 1. 兰州大学第二医院 泌尿外科,甘肃 兰州 730030
- 折叠
摘要
目的 采用meta分析经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)与经输尿管镜碎石术(ureteroscopic lithotripsy,URSL)治疗近端输尿管结石(≥10 mm)的有效性、安全性和潜在并发症.方法 采用PubMed、Web of Science、Cochrane Library进行系统文献检索,2024年4月前符合条件的比较PCNL与URSL治疗近端输尿管结石的文献均被纳入.采用Review Manager 5.4软件进行统计分析与显著性检验.结果 共纳入文献13篇,共涉及患者1 102例,PCNL 540例,URSL 562例,其中随机对照试验(randomized controlled trial,RCT)7 篇,非 RCT 6 篇.PCNL 手术时间[加权均数差(weighted mean difference,WMD)=20.46,95％CI 1.32～39.60,P=0.04]、总住院时间(WMD=2.31,95％CI 0.57～4.05,P＜0.01)、术后住院时间(WMD=2.83,95％CI 1.93～3.73,P＜0.01)均长于URSL,初始结石清除率[优势比(odds ratio,OR)=5.50,95％CI 2.04～14.85,P＜0.01]和最终结石清除率(OR=5.55,95％CI 3.48～8.87,P＜0.01)高于URSL.PCNL与URSL并发症发生率比较,差异无统计学意义(OR=0.96,95％CI 0.62～1.50,P=0.86);PCNL术后发热发生率(OR=1.85,95％CI 1.13～3.04,P=0.02)和输血率(OR=6.90,95％CI 1.77～26.89,P＜0.01)均高于URSL.结论 与URSL比较,PCNL治疗较大的近端输尿管结石更有效,但其危险性较高,具有更高的结石清除率、术后发热率和输血率.
Abstract
Objective To evaluate the efficacy,safety,and potential complications of percutaneous nephrolithotomy(PCNL)versus ureteroscopic lithotripsy(URSL)for the treatment of ≥10 mm proximal ureteral stones by a meta-analysis.Methods Eligible studies comparing PCNL with URSL for proximal ureteral stones through April 2024 were included in a systematic literature search using PubMed,Web of Science,and the Cochrane Library.The Review Manager 5.4 software was used to conduct statistical analyses and significance tests.Results Thirteen articles,including 7 randomized controlled trials(RCTs)and 6 non-RCTs,with a total of 1 102 patients(PCNL n=540,URSL n=562)were included.Operative time[weighted mean difference(WMD)=20.46,95％CI 1.32-39.60,P=0.04],total hospitalization time(WMD=2.31,95％CI 0.57-4.05,P＜0.01),and postoperative hospitalization time(WMD=2.83,95％CI 1.93-3.73,P＜0.01)of PCNL were longer than those of URSL,and initial stone-free rate[odds ratio(OR)=5.50,95％CI 2.04-14.85,P＜0.01]and final stone-free rate(OR=5.55,95％CI 3.48-8.87,P＜0.01)of PCNL were higher than those of URSL.The complication rates between PCNL and URSL showed no statistically significant difference(OR=0.96,95％CI 0.62-1.50,P=0.86).However,the incidence of postoperative fever(OR=1.85,95％CI 1.13-3.04,P=0.02)and blood transfusion rate(OR=6.90,95％CI 1.77-26.89,P=0.01)in PCNL were higher than those in URSL.Conclusion PCNL is more effective in treating larger proximal ureteral stones than URSL with a higher stone-free rate,but it is more dangerous with a higher postoperative fever and blood transfusion.
关键词
输尿管结石/经输尿管镜碎石术/经皮肾镜取石术/meta分析Key words
Ureterolithiasis/Ureteroscopic lithotripsy/Percutaneous nephrolithotripsy/Meta-analysis引用本文复制引用
基金项目
国家自然科学基金(82160146)
兰州大学第二医院萃英科技创新计划面上项目(CY2021-MS-A12)
出版年
2024
NETL
NSTL
万方数据