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目的:系统评价经皮肾镜取石术(PCNL)与输尿管软镜碎石术(RIRS)治疗肾结石的有效性及安全性,为临床选择提供依据。方法:制定检索策略后分别检索PubMed、Embase、Cochrane Library、中国知网、万方、维普数据库,全面收集有关上述两种手术方式治疗肾结石的随机对照研究(RCT),检索年限为建库至2016年5月,制定纳入和排除标准并据此筛选文献,资料提取后利用Revman 5.3软件进行Meta分析。结果:共纳入6篇文献的6项相互独立的随机对照研究,共计389例患者,其中PCNL组195例,RIRS组194例。Meta分析结果显示,PCNL的结石清除率大于RIRS(OR=2.48,95%CI 1.3~4.73,P=0.006),按照结石大小不同进行亚组分析,>2cm的肾结石PCNL的结石清除率大于RIRS(OR=4.53,95%CI 1.81~11.3,P=0.001),而<2cm的肾结石两者间差异无统计学意义(OR=2.78,95%CI 0.71~10.94,P=0.14);而在血红蛋白下降值方面,RIRS优于PCNL(MD=0.51,95%CI 0.17~0.85,P=0.004);另外,手术并发症(OR=2.0,95%CI 0.89~4.47,P=0.09)、术后住院时间(MD=0.74,95%CI-0.09~1.56,P=0.08)、平均手术时间(MD=0.24,95%CI-10.48~10.96,P=0.97)及重复治疗率(OR=0.85,95%CI 0.30~2.42,P=0.76)上,两者差异无统计学意义。结论:对于肾结石治疗,PCNL有更好的结石清除率(尤其是对于>2cm的肾结石);而RIRS治疗肾结石失血量更少。
OBJECTIVE: To systematically evaluate the effectiveness and safety of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (RIRS) in the treatment of renal calculi, and provide a basis for clinical choice. Methods: We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases respectively after the development of the search strategy. The randomized controlled study (RCT) on the treatment of kidney stones was collected comprehensively. In May 2016, the inclusion and exclusion criteria were formulated and the literature screened accordingly. Data were extracted and Meta-analysis was performed using Revman 5.3 software. RESULTS: Six independent RCTs were included in six articles, accounting for a total of 389 patients, including 195 in the PCNL group and 194 in the RIRS group. Meta analysis showed that the stone clearance rate of PCNL was higher than that of RIRS (OR = 2.48, 95% CI 1.3 ~ 4.73, P = 0.006). According to the different size of stones, (OR = 4.53, 95% CI 1.81-11.3, P = 0.001). There was no significant difference between the two groups (OR = 2.78,95% CI 0.71-10.94, P = 0.14) RIRS was superior to PCNL (MD = 0.51, 95% CI 0.17-0.85, P = 0.004) in terms of hemoglobin decline. In addition, complications (OR = 2.0,95% CI 0.89-4.47, P = 0.09) The average length of stay (MD = 0.74, 95% CI -0.09 to 1.56, P = 0.08), mean operative time (MD = 0.24, 95% CI 10.48 to 10.96, P 0.97) % CI 0.30 ~ 2.42, P = 0.76), the difference was not statistically significant. CONCLUSIONS: PCNL has a better stone clearance (especially for> 2 cm stones) for kidney stones, whereas RIRS has less blood loss for kidney stones.