[1]邓志权,罗道升,林伟卓,等.微创经皮肾镜与输尿管软镜治疗直径≤3 cm上尿路结石疗效与安全性的Meta分析[J].医学信息,2021,34(11):87-95.[doi:10.3969/j.issn.1006-1959.2021.11.025]
　DENG Zhi-quan,LUO Dao-sheng,LIN Wei-zhuo,et al.Meta-analysis of the Efficacy and Safety of Minimally Invasive Percutaneous Nephroscope and Flexible Ureteroscope in the Treatment of Upper Urinary Tract Stones with a Diameter of≤3 cm[J].Medical Information,2021,34(11):87-95.[doi:10.3969/j.issn.1006-1959.2021.11.025]
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微创经皮肾镜与输尿管软镜治疗直径≤3 cm上尿路结石疗效与安全性的Meta分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年11期
页码:
87-95
栏目:
论著
出版日期:
2021-06-01

文章信息/Info

Title:
Meta-analysis of the Efficacy and Safety of Minimally Invasive Percutaneous Nephroscope and Flexible Ureteroscope in the Treatment of Upper Urinary Tract Stones with a Diameter of≤3 cm
文章编号:
1006-1959（2021）11-0087-09
作者:
邓志权; 罗道升; 林伟卓; 等
（1.广东医科大学，广东 湛江 524000； 2.东莞市人民医院泌尿外科，广东 东莞 523000）
Author(s):
DENG Zhi-quan; LUO Dao-sheng; LIN Wei-zhuo; et al.
(1.Guangdong Medical University,Zhanjiang 524000,Guangdong,China; 2.Department of Urology,Dongguan People’s Hospital,Dongguan 523000,Guangdong,China)
关键词:
上尿路结石; 微创经皮肾镜; 输尿管软镜
Keywords:
Upper urinary tract stones; Minimally invasive percutaneous nephroscope; Flexible ureteroscopy
分类号:
R691.4
DOI:
10.3969/j.issn.1006-1959.2021.11.025
文献标志码:
A
摘要:
目的 利用系统评价分析微创经皮肾镜（≤20Fr）和输尿管软镜在治疗直径≤3 cm上尿路结石的疗效与安全性。方法 通过检索CNKI、万方数据库、VIP、SinoMed、Cochrane图书馆、PubMed、EMBase、Springer等电子数据库，搜集发表于2010年~2020年有关于微创经皮肾镜（≤20Fr）对比输尿管软镜治疗直径≤3 cm上尿路结石的临床研究，对所得文献进行严格筛选排除、风险质量评估及数据提取，运用RevMan5.3软件对数据进行Meta分析。结果 共计纳入随机对照试验14篇，非随机对照实验20篇。累计患者样本量3771例（微创经皮肾镜1918例，输尿管软镜1853例）。Meta分析结果显示微创经皮肾镜组结石清除率[OR=2.11,95%CI（1.66，2.67），P＜0.05]、手术时间[SMD=-5.80,95%CI（-6.60，-4.99），P＜0.05]、住院费用[SMD=-15.93,95%CI（-17.66，-14.20），P＜0.05]优于输尿管软镜组，差异有统计学意义；而输尿管软镜组术后轻度并发症[OR=2.37,95%CI（1.86，3.02），P＜0.05]、术后VAS评分[SMD=1.26,95%CI（1.18，1.33），P＜0.05]、术中出血量[SMD=15.73,95%CI（14.71，16.74），P＜0.05]、住院时间[SMD=1.87,95%CI（1.81，1.93），P＜0.05]优于微创经皮肾镜组，差异有统计学意义。两组术后发热率[OR=1.22,95%CI（0.91，1.65），P=0.19]比较，差异无统计学意义。结论 两种术式在治疗直径≤3 cm上尿路结石均具备良好的疗效和安全性，微创经皮肾镜在结石清除效率和经济方面具有优势，输尿管软镜则具有更好的安全性。
Abstract:
Objective To analyze the efficacy and safety of minimally invasive percutaneous nephroscope (≤20Fr) and flexible ureteroscopy in the treatment of upper urinary tract stones with a diameter of ≤3 cm.Methods By searching CNKI, Wanfang Database, VIP, SinoMed, Cochrane Library, PubMed, EMBase, Springer and other electronic databases,a collection of clinical studies published from 2010 to 2020 on minimally invasive percutaneous nephroscope (≤20Fr) versus flexible ureteroscopy in the treatment of upper urinary tract stones with a diameter of ≤3 cm.Strict screening and exclusion, risk quality assessment and data extraction were carried out on the obtained literature, and the data was meta-analyzed by RevMan5.3 software.Results A total of 14 randomized controlled trials and 20 non-randomized controlled trials were included. The cumulative sample size of patients was 3771 cases (1918 cases of minimally invasive percutaneous nephroscopy, 1853 cases of flexible ureteroscopy).Meta analysis results showed that the rate of stone clearance in the minimally invasive percutaneous nephroscope group [OR=2.11, 95%CI(1.66, 2.67),P＜0.05], operation time [SMD=-5.80, 95%CI (-6.60, -4.99) ),P＜0.05], hospitalization expenses [SMD=-15.93,95%CI(-17.66,-14.20),P＜0.05] was better than the flexible ureteroscopy group, the difference was statistically significant;In the flexible ureteroscopy group, postoperative complications [OR=2.37, 95%CI(1.86, 3.02),P＜0.05], postoperative VAS score [SMD=1.26, 95%CI(1.18, 1.33),P＜0.05], intraoperative blood loss [SMD=15.73, 95%CI(14.71, 16.74),P＜0.05], length of stay [SMD=1.87, 95%CI(1.81, 1.93),P＜0.05] was better than minimally invasive in the percutaneous nephroscope group, the difference was statistically significant.The postoperative fever rate [OR=1.22, 95%CI(0.91, 1.65),P=0.19] between the two groups was not statistically significant.Conclusion Both surgical methods have good efficacy and safety in the treatment of upper urinary tract stones with a diameter of ≤3 cm. Minimally invasive percutaneous nephroscope has advantages in stone removal efficiency and economy, and flexible ureteroscopy has better safety.

参考文献/References:

[1]Zeng G,Mai Z,Xia S,et al.Prevalence of kidney stones in China:an ultrasonography based cross-sectional study[J].BJU International,2017,120(1):109-116. [2]Holst DD, Bechis SK, Zupkas P,et al.Minimally Invasive Percutaneous Nephrolithotomy: Initial North American Experience[J]. J Endourol,2021,35(5):596-600. [3]冯瑞,李中兴,葛广成,等.超微通道经皮肾镜与组合式输尿管软镜治疗上尿路结石比较性研究[J].临床泌尿外科杂志,2018,33(2):121-125. [4]俞国锋,马伟雄,陈文璞,等.应用输尿管软镜碎石术与经皮肾镜取石术治疗肾结石的有效性和安全性[J].现代泌尿外科杂志,2018,23(12):925-927. [5]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. [6]Ergin G,Kirac M,Kopru B,et al.Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones[J].Urology Journal,2018,15(6):313-317. [7]Kirac M,Bozkurt OF,Tunc L,et al.Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm[J].Urolithiasis,2013,41(3):241-246. [8]Chen H,Qiu X,Du C,et al.The Comparison Study of Flexible Ureteroscopic Suctioning Lithotripsy With Intelligent Pressure Control Versus Minimally Invasive Percutaneous Suctioning Nephrolithotomy in Treating Renal Calculi of 2 to 3 cm in Size[J].Surgical Innovation,2019,26(5):528-535. [9]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 Journal of Urology,2015,33(11):1827-1831. [10]Li ZG,Zhao Y,Fan T,et al.Clinical effects of FURL and PCNL with holmium laser forthe treatment of kidney stones[J].Experimental and Therapeutic Medicine,2016,12(6):3653-3657. [11]Jin L,Yang B,Zhou Z.Comparative Efficacy on Flexible Ureteroscopy Lithotripsy andMiniaturized Percutaneous Nephrolithotomy for the Treatment of Medium-Sized Lower-PoleRenal Calculi[J].Journal of Endourology/Endourological Society,2019,33(11):914-919. [12]Sabnis RB,Ganesamoni R,Doshi A,et al.Micropercutaneous nephrolithotomy(micropercvs retrograde intrarenal surgery for the management of small renal calculi:a randomized controlled trial[J].BJU International,2013,112(3):355-361. [13]Zeng G,Zhang T,Agrawal M,et al.Super-mini percutaneous nephrolithotomy(SMP)vs retrograde intrarenal surgery for the treatment of 1~2 cm lower-pole renal calculi:an international multicentre randomised controlled trial[J].BJU International,2018,122(6):1034-1040. [14]Kandemir A,Guven S,Balasar M,et al.A prospective randomized comparison of micropercutaneous nephrolithotomy(Microperc)and retrograde intrarenal surgery(RIRS)for the management of lower pole kidney stones[J].World Journal of Urology,2017,35(11):1771-1776. [15]Demirbas A,Resorlu B,Sunay MM,et al.Which Should be Preferred for Moderate-Size Kidney Stones?Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery[J].Journal of Endourology/Endourological Society,2016,30(12):1285-1289. [16]Wilhelm K,Hein S,Adams F,et al.Ultra-mini PCNL versus flexible ureteroscopy:a matched analysis of analgesic consumption and treatment-related patient satisfaction in patientswith renal stones 10-35 mm[J].World Journal of Urology,2015,33(12):2131-2136. [17]Schoenthaler M,Wilhelm K,Hein S,et al.Ultra-mini PCNL versus flexible ureteroscopy:a matched analysis of treatment costs(endoscopes and disposables)in patients with renal stones 10-20 mm[J]. World Journal of Urology,2015,33(10):1601-1605. [18]Jiang K,Chen H,Yu X,et al.The"all-seeing needle"micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of≤2 cm[J].Urolithiasis,2019,47(2):201-206. [19]黄朝友,赖飞,钱友良,等.MPCNL和FURS治疗输尿管上段结石的效果比较[J].国际泌尿系统杂志,2017,37(2):174-177. [20]廖国栋,俞蔚文,章越龙,等.超微经皮肾镜和输尿管软镜治疗肾下极结石疗效及安全性的对比研究[J].中华泌尿外科杂志,2017,38(9):667-670. [21]陶荣镇,唐庆来,柳发德,等.超微经皮肾镜与输尿管软镜钬激光碎石治疗1~2 cm有症状肾下盏结石的疗效分析[J].国际泌尿系统杂志,2019,39(4):604-608. [22]陈科梁,鲁佩,杨杰,等.超微经皮肾镜与输尿管软镜治疗肾结石的疗效比较[J].现代泌尿外科杂志,2017,22(7):517-521. [23]崔振宇,杨文增,周洪月,等.多种微创手术治疗第4腰椎水平输尿管结石的对比研究[J].中华腔镜泌尿外科杂志(电子版),2017,11(2):45-48. [24]黄占洪,李文科,刘跃光,等.经皮肾镜取石术与输尿管软镜碎石术治疗肾下盏结石的疗效对比[J].腹腔镜外科杂志,2017,22(3):215-218. [25]陈健,杜耀安,李明,等.两种不同腔镜术式对复杂性输尿管上段结石患者临床疗效及安全性的影响[J].国际泌尿系统杂志,2019,39(4):612-615. [26]肖强,黄艳春.逆行肾内手术与经皮肾镜碎石术治疗直径小于1.5 cm肾盂结石的疗效比较[J].临床外科杂志,2015,23(2):113-115. [27]吴猛,刘良兵,易东风.软性输尿管镜钬激光碎石术与经皮肾镜碎石取石术治疗直径≤2 cm肾结石5年回顾性分析[J].临床外科杂志,2017,25(6):469-471. [28]杨嗣星,宋超,刘凌琪,等.输尿管镜下钬激光碎石与经皮肾镜取石术治疗肾结石的疗效比较[J].中华泌尿外科杂志,2013,34(9):666-669. [29]谭小宇,陈瑶,唐园,等.输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的疗效比较[J].微创泌尿外科杂志,2016,5(3):154-157. [30]颜姚,王强东,董振佳,等.输尿管软镜与微创经皮肾镜碎石术治疗2~3 cm肾下盏结石的疗效对比[J].国际泌尿系统杂志,2019,39(1):47-50. [31]钟键,卞卫星,仇佳星,等.输尿管软镜与微通道经皮肾镜治疗2~3 cm肾盂结石的疗效分析[J].中华腔镜泌尿外科杂志(电子版),2018,12(3):202-205. [32]陈广社,李锋.输尿管软镜与斜仰卧位微创经皮肾镜治疗输尿管上段结石的疗效比较[J].中华腔镜泌尿外科杂志(电子版),2015,9(5):21-24. [33]赵文超,郑明华,李文琦,等.微创经皮肾镜碎石术与输尿管软镜碎石术在治疗直径大于1 cm输尿管上段结石的临床疗效对比[J].微创泌尿外科杂志,2019,8(1):21-24. [34]鲁守会,许洪礼,鲁守琳,等.微通道经皮肾镜碎石术与逆行输尿管镜治疗肾下盏小结石的疗效分析[J].现代泌尿外科杂志,2018,23(4):283-286. [35]冯瑞,李中兴,葛广成,等.微通道经皮肾镜与组合式输尿管软镜碎石术治疗肾结石比较性研究[J].国际泌尿系统杂志,2017,37(2):165-170. [36]张弋,于澄钒,朱鹤,等.斜仰卧位微创经皮肾镜和输尿管软镜治疗输尿管上段结石的非随机比较研究[J].中华泌尿外科杂志,2013,34(10):775-778. [37]El Hamed AMA,Elmoghazy H,Aldahshoury M,et al.Single session vs two sessions offlexible ureterosopy(FURS)for dusting of renal pelvic stones 2-3 cm in diameter:Does stone size or hardness play a role in number of sessions to be applied?"[J].Turkish Journal of Urology,2017,43(2):158-161. [38]Zeng G,Wan S,Zhao Z,et al.Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation[J].BJU International,2016,117(4):655-661. [39]Zeng G,Zhu W,Liu Y,et al.The new generation super-mini percutaneous nephrolithotomy(SMP)system:a step-by-step guide[J].BJU International,2017,120(5):735-738. [40]Kadlec AO,Greco KA,Fridirici ZC,et al.Comparison of complication rates for unilateralandbilateral percutaneous nephrolithotomy(PCNL)using a modified Clavien grading system[J].BJU International,2013,111(4 Pt B):E243-8. [41]Bas O,Tuygun C,Dede O,et al.Factors affecting complication rates of retrograde flexible ureterorenoscopy:analysis of 1571 procedures-a single-center experience[J].World Journal of Urology,2017,35(5):819-826. [42]Zhao Z,Tuerxu A,Liu Y,et al.Super-mini PCNL(SMP):Material,indications,technique,advantages and results[J].Archivos Espanoles De Urologia,2017,70(1):211. [43]Sugihara T,Yasunaga H,Horiguchi H,et al.A nomogram predicting severe adverse events after ureteroscopic lithotripsy:12372 patients in a Japanese national series[J].BJU International,2013,111(3):459-466.

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更新日期/Last Update: 1900-01-01