Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
Int J Surg. 2019 Nov;71:1-11. doi: 10.1016/j.ijsu.2019.09.005. Epub 2019 Sep 12.
The purpose of this study was to retrospectively assess the efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) in the management of upper urinary stones.
A comprehensive literature review of articles that investigated the efficacy and safety of MPCNL and RIRS was conducted by systematically searching PubMed, EMBASE, and Cochrane Library in March 2019. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software.
Eight randomized controlled trials (RCTs) involving 725 patients with upper urinary stones were analysed based on the inclusion criteria. While MPCNL has a better clinical efficacy than RIRS with respect to the stone-free rate (SFR) [RR = 1.11, 95% CI (1.05-1.17), p = 0.0005], MPCNL has a higher incidence of haematoma [RR = 3.09, 95% CI (1.44-6.66), p = 0.004] and longer hospitalization time [MD = 0.89 day, 95% CI (0.07-1.72), p = 0.04]. In addition, no significant difference in operative time [MD = 2.46 min, 95% CI (-17.99 to 22.92), p = 0.81] and postoperative pain score [MD = 0.74, 95% CI (-0.45 to 1.94), p = 0.22] were observed between the two methods. Overall, the evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with RIRS.
Our data suggest that MPCNL is an effective method for treating upper urinary stones, especially lower calyceal stones that are 1-2 cm in size. Compared to RIRS, MPCNL is associated with a longer hospital stay time and a higher incidence of haematoma. In addition, both methods have proven to be safe. Nevertheless, the findings should be further confirmed through well-designed prospective RCTs with a larger patient series.
本研究旨在回顾性评估微创经皮肾镜取石术（MPCNL）与逆行肾内手术（RIRS）治疗上尿路结石的疗效和安全性。
通过系统检索 2019 年 3 月 PubMed、EMBASE 和 Cochrane Library 中的文献，对 MPCNL 和 RIRS 疗效和安全性的研究进行全面文献回顾。两位审查员根据纳入和排除标准独立搜索文献、提取数据并评估数据质量。使用 Review Manager 5.3 软件进行荟萃分析。
根据纳入标准，对 8 项涉及 725 例上尿路结石患者的随机对照试验（RCT）进行了分析。虽然 MPCNL 在结石清除率（SFR）方面优于 RIRS [RR=1.11，95%CI（1.05-1.17），p=0.0005]，但 MPCNL 血肿发生率更高[RR=3.09，95%CI（1.44-6.66），p=0.004]，住院时间更长[MD=0.89 天，95%CI（0.07-1.72），p=0.04]。此外，两种方法在手术时间[MD=2.46 分钟，95%CI（-17.99 至 22.92），p=0.81]和术后疼痛评分[MD=0.74，95%CI（-0.45 至 1.94），p=0.22]方面无显著差异。总体而言，证据不足以表明 MPCNL 与 RIRS 相比在不良事件谱方面存在统计学显著差异。
我们的数据表明，MPCNL 是治疗上尿路结石的有效方法，特别是对于 1-2cm 大小的下盏结石。与 RIRS 相比，MPCNL 与住院时间延长和血肿发生率增加有关。此外，两种方法均已被证明是安全的。然而，这些发现需要通过具有更大患者系列的精心设计的前瞻性 RCT 进一步证实。
