逆行输尿管软镜激光碎石治疗肾结石的荟萃分析

目的:系统评价逆行输尿管软镜激光碎石术治疗肾结石具有的优势。方法:通过检索Pubmed、Cochrane library、CBMdisc、EMBASE、CNKI等数据库有关逆行输尿管软镜激光碎石术与经皮肾镜取石术(Percutaneous nephrolithotomy,PCNL)治疗肾结石的对照试验文献,并追查纳入文献的参考文献,对符合纳入标准的研究使用统计软件RevMan5.2完成Meta分析。结果:经筛选,最后纳入8篇文献,共590例,进行Meta分析,与肾镜组比较,软镜组:(1)结石清除率(RR 0.95,95%CI 0.88至1.02,P=0.15)和术后发热率(RR 0.95,95%CI 0.54至1.67,P=0.85)无统计学意义;(2)平均手术时间延长19.11分钟(WMD19.11,95%CI 7.83至30.39,P0.05);(3)平均住院时间减少2.1天(WMD-2.1,95%CI-3.08至-1.11,P0.05);(4)出血发生率显著降低(RR 0.20,95%CI 0.06至0.68,P=0.01).结论:与PCNL比较,逆行输尿管软镜激光碎石术具有住院时间短,出血并发症低的优势。

Meta-analysis of retrograde intrarenal surgery in the treatment of renal stones

Objective To systematically review the advantages of the retrograde intrarenal surgery in the treatment of renal stones.Methods We searched Pubmed Cochrane library,CBMdisc,Embase,wanfang,VIP and other databases about the retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of renal stones. All clinical trials were retrieved and their included references were investigated. The eligible studies were included and analyzed using RevMan 5.2. Results Eight literatures were retrieved, including 590 patients. The Meta-analysis results showed that, compared with percutaneous nephrolithotomy group,the patients in retrograde intrarenal surgery group had the following features：（1） the stone-free rate（95% confidence interval 0.88 to 1.02,P=0.15） and postoperative fever（95%confidence interval 0.54 to 1.67,P=0.85）were not significant difference between two groups;（2） The mean operation time was prolonged an average of 19.11 minutes（ 95% confidence interval, 7.83 to 30.39, P〈0.05）;（3）The hospitalization stay was shortened an average of 2.1 days（95% confidence interval,-3.08 to-1.11, P〈0.05）;（4） Incidence of bleeding of the retrograde intrarenal surgery group was lower（95% confidence interval, 0.06～0.68,P=0.01）.Conclusion Compared with percutaneous nephrolithotomy,our results showed that retrograde intrarenal surgery shorten the hospitalization stay and reduced complications, which was significantly superior to percutaneous nephrolithotomy.