中国循证医学杂志

中国循证医学杂志

腹腔镜下肾盂切开取石术与经皮肾镜取石术比较治疗肾盂大结石疗效与安全性的Meta 分析

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目的系统评价腹腔镜下肾盂切开取石术(LP)与经皮肾镜取石术(PNL)比较治疗肾盂大结石(结石长径大于 2 cm)的疗效与安全性。方法计算机检索 PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI 和 WanFang Data 数据库,搜集有关 LP 与 PNL 比较治疗肾盂大结石的随机对照试验(RCT),检索时限均从建库至 2017 年 9 月 23 日。由 2 名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5.2 软件进行 Meta 分析。结果共纳入 5 个 RCT,包括 447 例患者。Meta 分析结果显示:LP 组术后 3 个月结石清除率高于 PNL 组[RR=1.07,95%CI(1.01,1.13),P=0.01];LP 组在辅助手术率[RR=0.36,95%CI(0.13,1.01),P=0.05]、术后血红蛋白下降值[MD=–0.83,95%CI(–1.05,–0.61),P<0.000 01]和术后发热发生率[RR=0.36,95%CI(0.18,0.72),P=0.004]方面均低于 PNL 组;而两者在转开放手术率[RR=0.76,95%CI(0.19,3.07),P=0.70]、输血率[RR=0.40,95%CI(0.14,1.12),P=0.08]、术后尿漏发生率[RR=1.87,95%CI(0.67,5.21),P=0.23]、手术时间[MD=10.49,95%CI(–17.14,38.13),P=0.46]及住院时间[MD=0.53,95%CI(–0.22,1.28),P=0.17]方面,差异均无统计学意义。结论当前证据表明,对于肾盂大结石的治疗,LP 在结石清除率、辅助手术率、术后血红蛋白下降及术后发热发生率方面均优于 PNL。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。

ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.

关键词: 肾盂切开取石术; 经皮肾镜取石术; 肾盂结石; 随机对照试验; Meta分析

Key words: Pyelolithotomy; Percutaneous nephrolithotomy; Renal pelvic calculi; Randomized controlled trial; Meta-analysis

引用本文: 刘伟, 杨恩广, 郜栋阳, 庞阳阳, 田金徽, 郭琦, 龚玉雯, 李谛音, 张涛, 王羽含, 王志平. 腹腔镜下肾盂切开取石术与经皮肾镜取石术比较治疗肾盂大结石疗效与安全性的Meta 分析. 中国循证医学杂志, 2018, 18(9): 947-952. doi: 10.7507/1672-2531.201711120 复制

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