Chang Xueliang, Yang Zhan, Wang Xiaowei, Wang Hu, Wang Yaxuan, Han Zhenwei
Department of Urology, The Second Hospital of Hebei Medical University, Hebei, China.
Department of Urology, The First Hospital of Hebei Medical University, Hebei, China.
Wideochir Inne Tech Maloinwazyjne. 2023 Mar;18(1):42-51. doi: 10.5114/wiitm.2022.119776. Epub 2022 Sep 24.
Both percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU) are effective treatment options for large proximal ureteral stones.
To perform a meta-analysis on this topic to assess the efficacy, safety, and potential complications of the two procedures.
A systematic literature search was performed using PubMed, Ovid and Scopus to identify eligible suitable studies until May 2022. All studies comparing LU vs PCNL in large proximal ureteral stones were included. The Cochrane Collaboration's Review Manager (RevMan) 5.4 software was used to analyze statistical significance.
A total of nine publications involving 933 patients (LU 465; PCNL 468) were included, of which 4 were randomized control trails (RCTs) and 5 were non-RCTs. The meta-analysis of available data showed that compared with PCNL, LU had a higher initial stone-free rate (OR = 3.26; p = 0.004), but longer operative time (WMD = 35.08 min; p = 0.0003). However, the final stone-free rate (OR = 2.08; p = 0.07) and length of hospital stay (WMD = 0.32 d; p = 0.48) were comparable between the two groups. Meanwhile, LU had a lower transfusion rate (OR = 0.13; p = 0.007) than PCNL. There was no significant difference in terms of complications (OR = 0.97; p = 0.84), Clavien-Dindo score ≥ 3 complications (OR = 1.03; p = 0.93), auxiliary procedures (OR = 0.44; p = 0.08), or ureteral stenosis (OR = 0.24; p = 0.13) between LU and PCNL.
Our meta-analysis revealed that LU is a safe and feasible option for large proximal ureteral stones with a higher initial stone-free rate and lower transfusion rate compared with PCNL.
经皮肾镜取石术（PCNL）和腹腔镜输尿管切开取石术（LU）都是治疗大型近端输尿管结石的有效方法。
对该主题进行荟萃分析，以评估这两种手术的疗效、安全性和潜在并发症。
利用PubMed、Ovid和Scopus进行系统的文献检索，以确定截至2022年5月符合条件的合适研究。纳入所有比较LU与PCNL治疗大型近端输尿管结石的研究。使用Cochrane协作网的Review Manager（RevMan）5.4软件分析统计学意义。
共纳入9篇涉及933例患者的文献（LU组465例；PCNL组468例），其中4篇为随机对照试验（RCT），5篇为非RCT。对现有数据的荟萃分析表明，与PCNL相比，LU的初始结石清除率更高（OR = 3.26；p = 0.004），但手术时间更长（WMD = 35.08分钟；p = 0.0003）。然而，两组的最终结石清除率（OR = 2.08；p = 0.07）和住院时间（WMD = 0.32天；p = 0.48）相当。同时，LU的输血率低于PCNL（OR = 0.13；p = 0.007）。LU与PCNL在并发症（OR = 0.97；p = 0.84）、Clavien-Dindo评分≥3级并发症（OR = 1.03；p = 0.93）、辅助手术（OR = 0.44；p = 0.08）或输尿管狭窄（OR = 0.24；p = 0.13）方面无显著差异。
我们的荟萃分析表明，对于大型近端输尿管结石，LU是一种安全可行的选择，与PCNL相比，其初始结石清除率更高，输血率更低。
