背景:肾内逆行手术(RIRS)和微创经皮肾镜取石术(mPCNL)治疗上尿路结石的优缺点尚未确定。
方法:在本荟萃分析中,我们全面评估了两种手术方法在上尿路结石治疗中的表现。我们搜查了Pubmed,Embase,截至2022年12月,Cochrane和WebofScience数据库关于RIRS和mPCNL的随机对照试验(RCT)文章。数据由两名独立审阅者提取,并使用Stata15.1软件进行荟萃分析(StataSE,美国)。
结果:本研究共纳入18个符合条件的RCTs,涉及1733例患者。荟萃分析显示,1-2cm或2-3cm结石的mPCNL具有较高的结石清除率(RR:1.08,95CI(1.03,1.14),p=0.002)和更短的操作时间(大规模杀伤性武器:-10.85分钟,95CI(-16.76,-4.94),p<0.001)。然而,它与更多的住院时间相关(大规模杀伤性武器:1.01天,95CI(0.53,1.5),p<0.001),血红蛋白滴(WMD:0.27g/dl,95CI(0.14,0.41),p<0.001),输血率(RR:5.04,95CI(1.62,15.65),p=0.005),疼痛视觉模拟评分(WMD:0.75,95CI(0.04,1.46),p=0.037),医院费用(SMD:-0.97,95CI(-1.19,-0.76),p<0.001)和主要并发症(RR:1.89,95CI(1.01,3.53),p=0.045)。
结论:因此,就手术效果和手术时间而言,mPCNL优于RIRS,但在其他围手术期参数方面较差。在临床决策中应充分考虑这些因素。
BACKGROUND: The advantages and disadvantages of retrograde intrarenal surgery (
RIRS) and minimally invasive percutaneous nephrolithotomy (mPCNL) for treatment of upper urinary tract calculi have not been conclusively determined.
METHODS: In this meta-analysis, We comprehensively evaluated the performance of the two surgical approaches in treatment of upper urinary calculi. We searched the Pubmed, Embase, Cochrane and Web of science databases for randomized controlled trial (RCT) articles on
RIRS and mPCNL upto December 2022. Data were extracted by two independent reviewers and subjected to the meta-analysis using the Stata 15.1 software (StataSE, USA).
RESULTS: A total of 18 eligible RCTs involving 1733 patients were included in this study. The meta-analysis revealed that mPCNL of 1-2 cm or 2-3 cm stones had a higher stone clearance rate (RR:1.08, 95%CI (1.03, 1.14), p = 0.002) and shorter operation time (WMD : -10.85 min, 95%CI (-16.76, -4.94), p<0.001). However, it was associated with more hospital stay time (WMD :1.01 day, 95%CI(0.53, 1.5), p<0.001), hemoglobin drops (WMD :0.27 g/dl, 95%CI (0.14, 0.41), p<0.001), blood transfusion rate (RR:5.04, 95%CI(1.62, 15.65), p = 0.005), pain visual analogue score (WMD:0.75, 95%CI (0.04, 1.46), p = 0.037), hospital costs (SMD :-0.97, 95%CI (-1.19, -0.76), p<0.001) and major complications (RR:1.89, 95%CI(1.01, 3.53), p = 0.045).
CONCLUSIONS: Therefore, in terms of surgical effects and operation time, mPCNL is superior to
RIRS, but is inferior with regards to other perioperative parameters. These factors should be fully considered in clinical decision making.