Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Urol J. 2020 Jul 30;18(1):11-18. doi: 10.22037/uj.v16i7.5588.
We aimed to compare the safety and efficacy between laparoscopic transperitoneal ureterolithotomy (LTU) and laparoscopic retroperitoneal ureterolithotomy (LRU) in the treatment of large (>10mm) and proximal ureteral stones.
Electronic databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were searched through December 2019. Comparative studies comparing the two approaches were included. The primary outcome was a single-procedure success rate; the secondary outcomes included operative time, hospital duration, and complications (according to the Clavien-Dindo Grade). Newcastle-Ottawa scale (NOS) and the modified Jadad scale were used to evaluate the quality of the included studies. The Egger's test estimated publication bias. The meta-analysis was performed by Review Manager 5.3 and STATA 15.0.
Seven studies, involving 125 participants in LTU group and 128 in LRU group, were included in the study. The results suggested that both single-procedure success rate and the rate of postoperative paralytic ileus were significantly higher in the LTU group than in the LRU group (95.2% vs 87.5%, 95% CI: .00-.16, RD = .08, P = .04; 10.4% vs 0, 95% CI: .02- .19, RD = .10, P = .02, respectively). No publication bias of the primary outcome was observed with the Egger's test (P = .117). No significant differences were noted in terms of operative time and hospital duration (95% CI: -18.95-8.80, MD = -5.08, P = .47; 95% CI: -.98- .58, MD = -.20, P = .61, respectively). Additionally, according to Clavien-Dindo Grade, the rates of major complications (>= Grade 3a) including open conversion (.8% vs 5.5%, 95%CI: -.11- .01, RD = -.05, P = .12), stone migration (8.1% vs 6.7%, 95% CI: -.08- .11, RD = .02, P = .76), vascular injury (5.4% vs 0, 95%CI: -.03- .14, RD = .05, P = .21) and ureteral stricture (1.3% vs 5.3%, 95% CI: -.11- .02, RD = -.04, P = .20), were comparable between the two groups.
In the treatment of large and proximal ureteral calculi, LTU has a significantly higher single-procedure success rate and a higher rate of postoperative paralytic ileus than LRU. However, the complication was well-tolerated. The small sample size and limited, including studies, were the main limitations.
比较腹腔镜经腹腔输尿管切开取石术（LTU）与腹腔镜经腹膜后输尿管切开取石术（LRU）治疗>10mm 大和上段输尿管结石的安全性和疗效。
通过 2019 年 12 月对 PubMed、EMBASE、Cochrane 图书馆、Web of Science 和 Scopus 等电子数据库进行检索，纳入比较两种方法的研究。主要结局是单次手术成功率；次要结局包括手术时间、住院时间和并发症（根据 Clavien-Dindo 分级）。采用纽卡斯尔-渥太华量表（NOS）和改良 Jadad 量表评估纳入研究的质量。Egger 检验估计发表偏倚。Meta 分析采用 Review Manager 5.3 和 STATA 15.0 进行。
纳入 7 项研究，LTU 组 125 例，LRU 组 128 例。结果表明，LTU 组的单次手术成功率和术后麻痹性肠梗阻发生率均显著高于 LRU 组（95.2%比 87.5%，95%CI：.00-0.16，RD =.08，P =.04；10.4%比 0，95%CI：.02-0.19，RD =.10，P =.02）。Egger 检验未发现主要结局的发表偏倚（P =.117）。手术时间和住院时间无显著差异（95%CI：-18.95-8.80，MD = -5.08，P =.47；95%CI：-.98-0.58，MD = -.20，P =.61）。此外，根据 Clavien-Dindo 分级，两组主要并发症（>= Grade 3a）发生率，包括中转开放手术（8.1%比 5.5%，95%CI：-.11-0.01，RD = -.05，P =.12）、结石移位（8.1%比 6.7%，95%CI：-.08-0.11，RD =.02，P =.76）、血管损伤（5.4%比 0，95%CI：-.03-0.14，RD =.05，P =.21）和输尿管狭窄（1.3%比 5.3%，95%CI：-.11-0.02，RD = -.04，P =.20），两组间无差异。
在治疗大的和上段输尿管结石时，LTU 的单次手术成功率显著高于 LRU，且术后麻痹性肠梗阻发生率更高。然而，并发症可以很好地耐受。小样本量和有限的纳入研究是主要的局限性。
