10 - 20毫米下极结石最佳治疗方法的荟萃分析：可弯曲输尿管镜检查（FURS）与体外冲击波碎石术（ESWL）对比经皮肾镜取石术（PCNL）

Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL).

作者信息

Yuri Prahara, Hariwibowo Rinto, Soeroharjo Indrawarman, Danarto Raden, Hendri Ahmad Z, Brodjonegoro Sakti R, Rasyid Nur, Birowo Ponco, Widyahening Indah S

机构信息

Division of Urology, Department of Surgery, Faculty of Medicine Universitas Gadjah Mada - Sardjito Hospital, Yogyakarta, Indonesia.

出版信息

Acta Med Indones. 2018 Jan;50(1):18-25.

PMID:29686172

Abstract

BACKGROUND

the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones.

METHODS

a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3.

RESULTS

we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 - 1.55); p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 - 1.55); p=<0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 - 1.30; p=0.01 and I2=40%).

CONCLUSION

percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.

摘要

背景

下盏结石的最佳治疗方案仍存在争议，因为没有单一方法适用于清除所有下盏结石。体外冲击波碎石术（ESWL）、经皮肾镜取石术（PCNL）和软性输尿管镜检查（fURS）等微创手术是治疗下盏结石的方法。本研究旨在确定10 - 20毫米下极结石的最佳治疗方案。

方法

从Medline和Cochrane数据库对2016年7月之前发表的队列研究进行荟萃分析。纳入接受fURS、ESWL和PCNL治疗的10 - 20毫米下极结石患者，术后1 - 3个月随访残余结石情况，排除其他部位和大小的尿路结石。采用Mantzel - Haenzel方法的固定效应模型计算合并风险比（RRs）和95%置信区间（CIs）。通过计算I²统计量评估异质性。所有分析均使用Review manager 5.3进行。

结果

我们分析了8项队列研究。958例患者（271例行PCNL，174例行fURS，513例行ESWL）术后3个月的结石清除率分别为：PCNL术后90.8%（246/271）；fURS术后75.3%（131/174）；ESWL术后64.7%（332/513）。基于10 - 20毫米下极结石治疗后的结石清除率，PCNL优于fURS（总体RR为1.32（95%CI 1.13 - 1.55）；p<0.001且I² = 57%）和ESWL（总体风险比1.42（95%CI 1.30 - 1.55）；p = <0.001且I² = 85%）。但是，如果我们比较fURS和ESWL，则在10 - 20毫米下极结石治疗的结石清除率方面，fURS优于ESWL，总体RR为1.16（95%CI 1.04 - 1.30；p = 0.01且I² = 40%）。