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中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 220 -223. doi: 10.3877/cma.j.issn.1674-3253.2018.04.002

所属专题: 文献

临床研究

超微经皮肾镜与输尿管软镜处理<3 cm肾结石的Meta分析
徐煜宇1, 袁耀基1, 黄晨1, 梁健1, 李逊2, 何永忠2, 杨炜青2, 徐桂彬2,()   
  1. 1. 510700 广州医科大学附属第五医院泌尿外科;510000 广州医科大学研究生院
    2. 510700 广州医科大学附属第五医院泌尿外科
  • 收稿日期:2017-05-16 出版日期:2018-08-01
  • 通信作者: 徐桂彬
  • 基金资助:
    广东省自然科学基金(2015A030310530); 广州市教育局创新团队项目(13C10)

Meta-analysis of micro-percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones smaller than 3 cm

Yuyu Xu1, Yaoji Yuan1, Chen Huang1, Jian Liang1, Xun Li2, Yongzhong He2, Weiqing Yang2, Guibin Xu2,()   

  1. 1. Department of Urology, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China;Graduate School of Guangzhou Medical University, Guangzhou 510000, China
    2. Department of Urology, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China
  • Received:2017-05-16 Published:2018-08-01
  • Corresponding author: Guibin Xu
  • About author:
    Corresponding author: Xu Guibin, Email:
引用本文:

徐煜宇, 袁耀基, 黄晨, 梁健, 李逊, 何永忠, 杨炜青, 徐桂彬. 超微经皮肾镜与输尿管软镜处理<3 cm肾结石的Meta分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(04): 220-223.

Yuyu Xu, Yaoji Yuan, Chen Huang, Jian Liang, Xun Li, Yongzhong He, Weiqing Yang, Guibin Xu. Meta-analysis of micro-percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones smaller than 3 cm[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(04): 220-223.

目的

系统回顾分析输尿管软镜碎石取石术(RIRS)与超微经皮肾镜碎石取石术(micro-PCNL)处理肾结石(<3 cm)的有效性与安全性。

方法

通过检索Pubmed、Cochrane图书馆、Embase、中国知网、万方数据库及中国生物医学文献服务系统等数据库(2011-01-01至2017-03-01),获得有关micro-PCNL与RIRS处理中小肾结石的相关临床试验的中英文文献。根据研究纳入及排除标准,对纳入文献提取相关临床试验数据,经Revman 5.0分析软件分析得出结论。

结果

本研究总共纳入4篇文献,2篇为随机对照试验,2篇为回顾性分析试验,所有文献总共纳入328例患者。RIRS与micro-PCNL的住院时间[WMD=2.71,95%CI(-3.78,9.20)],手术时间[WMD=6.56,95%CI(-22.94,36.05)]、及术后并发症[OR=0.99,95%CI(0.51,1.95)]等差异无统计学意义,而在结石清除率中,micro-PCNL优于RIRS[OR=2.30,95%CI(1.24,4.26)],且差异具有统计学意义。

结论

两种术式均安全有效,micro-PCNL结石清除率高于RIRS。

Objective

To systematically analyze the clinical efficacy and safety of micro-percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of kidney stones that measure smaller than 3 cm.

Methods

Through searching PubMed, Cochrane library, Embase, CNKI, Wanfang database and SinoMed, clinical trials related to micro-PCNL and RIRS in treating small-and medium-size kidney stones in both Chinese and English from January 1, 2011 to March 1, 2017 were retrieved. According to the inclusion and exclusion criteria, relevant clinical trial data were extracted from the literatures and statistically analyzed by Revman 5.0 software to draw a conclusion.

Results

Four articles consisting of 328 patients were included in this meta-analysis, including two randomized controlled trials and two retrospective trials. No statistical significance was noted in terms of the length of hospital stay [(WMD=2.71, 95%CI (-3.78,9.20)], operation time (WMD=6.56, 95%CI (-22.94,36.05)] and postoperative complications [OR=0.99, 95%CI (0.51,1.95)] between RIRS and micro-PCNL, whereas the removal rate of kidney stones by micro-PCNL was significantly higher compared with that by RIRS (OR=2.30, 95%CI (1.24,4.26)].

Conclusion

Both micro-PCNL and RIRS are efficacious and safe in the treatment of kidney stones, whereas the removal rate of micro-PCNL is considerably higher than that by RIRS.

表1 纳入文献质量评分
表2 纳入文献的基本特征
[1]
Armagan A,Karatag T,Buldu I, et al. Comparison of flexible ureterorenoscopy and micropercutaneous nephrolithotomy in the treatment for moderately size lower-pole stones[J]. World J Urol, 2015, 33(11): 1827-1831.
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Bagcioglu M,Demir A,Sulhan H, et al. Comparison of flexible ureteroscopy and micropercutaneous nephrolithotomy in terms of cost-effectiveness: analysis of 111 procedures[J]. Urolithiasis, 2016, 44(4): 339-344.
[3]
Ramón de Fata F,García-Tello A,Andrés G, et al. Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones[J]. Actas Urol Esp, 2014, 38(9):576-583.
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Sabnis RB,Ganesamoni R,Doshi A, et al. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial[J]. BJU Int, 2013, 112(3): 355-361.
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Palmero JL,Durán-Rivera AJ,Miralles J, et al. Comparative study for the efficacy and safety of percutaneous nefhrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of 2-3,5 cm kidney stones[J]. Arch Esp Urol, 2016, 69(2): 67-72.
[6]
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Wilhelm K1,Fritsche HM2,Netsch C, et al. Percutaneous Stone Treatment Today: Standard-, Mini-, Micro-, Ultramini-PCNL[J]. Aktuelle Urol, 2015. 46(4): 297-302.
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