输尿管硬镜碎石术与经皮肾镜取石术治疗近端输尿管大结石的Meta分析

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis.

作者信息

Wang Qing, Guo Jiachao, Hu Henglong, Lu Yuchao, Zhang Jiaqiao, Qin Baolong, Wang Yufeng, Zhang Zongbiao, Wang Shaogang

机构信息

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

出版信息

PLoS One. 2017 Feb 9;12(2):e0171478. doi: 10.1371/journal.pone.0171478. eCollection 2017.

OBJECT

To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones.

METHODS

A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software.

RESULTS

Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, -45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, -3.51 to -2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable.

CONCLUSIONS

Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.

目的

比较硬性输尿管镜碎石术（rigid URSL）与经皮肾镜取石术（PCNL）治疗近端输尿管大结石的安全性和有效性。

方法

系统检索PubMed、EMBASE、Cochrane图书馆和Web of Science数据库以查找相关研究。根据预定的纳入和排除标准进行文献筛选，提取符合条件研究的数据，然后通过RevMan 5.3软件进行荟萃分析。

结果

纳入5项随机对照试验（RCT）、1项前瞻性队列研究和4项回顾性队列研究，共837例患者。接受硬性输尿管镜碎石术的患者手术时间较短（加权均数差，-23.66分钟；95%可信区间，-45.00至-2.32；p = 0.03），住院时间较短（加权均数差，-2.76天；95%可信区间，-3.51至-2.02；p<0.00001），术后第3天（风险比，0.73；95%可信区间，0.66至0.82；p < 0.00001）和第1个月（风险比，0.82；95%可信区间，0.77至0.87；p < 0.00001）结石清除率较低，转为其他手术的风险较高（风险比，4.28；95%可信区间，1.93至9.46；p = 0.0003），结石移位（风险比，28.49；95%可信区间，9.12至89.00；p < 0.00001）和输尿管穿孔（风险比，6.06；95%可信区间，1.80至20.44；p = 0.004）的发生率较高，发热（风险比，0.64；95%可信区间，0.42至0.97；p = 0.04）、输血（风险比，0.19；95%可信区间，0.04至0.85；p = 0.03）和血尿（风险比，0.38；95%可信区间，0.25至0.57；p < 0.0001）的风险较低。在栓塞、疼痛和输尿管狭窄的发生率方面未观察到显著差异。当排除队列研究或使用软性输尿管镜作为术中辅助操作的研究时，我们发现大多数结果保持稳定。