标题：硕通镜与经皮肾镜取石术治疗上尿路结石的Meta分析

      作者：顾君，吴海超，何泽喜，丁明霞    昆明医科大学第二附属医院泌尿外科，云南省泌尿外科研究所，云南 昆明 650101

      卷次： 2021年32卷20期

      【摘要】 目的 系统评价硕通镜与经皮肾镜取石术(PCNL)治疗上尿路结石的有效性和安全性。方法 检索英文数据库PubMed、The Cochrane Library、EMbase和中文数据库CNKI、万方、维普和CBM数据库，检索时限均为建库至2021年3月，根据本研究的纳排标准筛选出硕通镜与PCNL治疗上尿路结石的临床对照研究，对纳入文献进行文献质量评价和数据提取，使用Revman 5.4进行Meta分析。结果 本研究最终共纳入 9篇文献 835例患者。Meta分析显示：与PCNL组相比，硕通镜组术后 1 d结石清除率(OR=0.47，95%CI：0.26~0.82，P=0.008)、术后 1个月结石清除率(OR=0.17，95%CI：0.07~0.39，P<0.000 1)、术后结石清除有效率(OR=0.50，95%CI：0.29~0.84，P=0.009)低，并发症发生情况少(OR=0.30，95%CI：0.19~0.47，P<0.000 01)，手术时间更短(MD=-15.30，95%CI：-25.01~-5.60，P=0.002)，术中出血量更少 (MD=-27.50，95%CI：-35.71~-19.28，P<0.000 01)、术后住院时间更短 (MD=-2.18，95%CI：-2.54~-1.83，P<0.000 01)。结论 两种手术方式均安全有效，硕通镜取石术在结石清除率上可能不如经皮肾镜，但其不失为一种安全性更高的手术方式，未来还需要更多高质量的前瞻性实验加以验证，以更好地为临床治疗选择提供循证证据。
      【关键词】 硕通镜；经皮肾镜；肾结石；输尿管结石；Meta分析
      【中图分类号】 R691.4 【文献标识码】 A 【文章编号】 1003—6350（2021）20—2708—08

Meta-analysis of negative pressure combined with ureteroscopy and percutaneous nephrolithotomy for upperurinary calculi.
GU Jun, WU Hai-chao, HE Ze-xi, DING Ming-xia. Department of Urology, the Second Affiliated Hospitalof Kunming Medical University, Yunnan Institute of Urology, Kunming 650101, Yunnan, CHINA
【Abstract】 Objective To systematically evaluate the clinical efficacy and safety of negative pressure combinedwith ureteroscopy and percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary calculi. Methods Throughsearching PubMed, the Cochrane library, Embase, CNKI, VIP, CBM and Wanfang database, controlled clinical trial relatedto negative pressure combined with ureteroscopy and percutaneous nephrolithotomy in treating upper urinary calculiin both Chinese and English from inception to March 1, 2021 were retrieved according to the inclusion and exclusioncriteria. The meta-analysis was performed using RevMan 5.4 software after quality evaluation and data extraction.Results Nine articles consisting of 835 patients were included in this meta-analysis, including one randomized con-trolled trial and eight retrospective trials. The removal rate of urinary calculi on the first day (OR=0.47, 95% CI:0.26-0.82, P=0.008) and first month (OR=0.17, 95%CI: 0.07-0.39, P<0.000 1) after surgery, the total removal rate ofurinary calculi (OR=0.50, 95%CI: 0.29-0.84, P=0.009) by PCNL were higher compared with those by negative pressurecombined with ureteroscopy, whereas postoperative complications (OR=0.30, 95%CI: 0.19-0.47, P<0.000 01), operationtime (MD=-15.30, 95% CI: -25.01 to 5.60, P=0.002), surgical blood loss (MD=-27.50, 95% CI: -35.71 to 19.28, P<0.000 01) and the length of postoperative hospital stay (MD=-2.18, 95%CI: -2.54 to 1.83, P<0.001) by negative pres-sure combined with ureteroscopy was significantly higher compared with that by PCNL. Conclusion Both negativepressure combined with ureteroscopy and PCNL are efficacious and safe in the treatment of upper urinary calculi, where-as the security of negative pressure combined with ureteroscopy is considerably higher than that by percutaneous nephroli-thotomy. The conclusions have yet to be validated by more high-quality prospective studies in order to guide clinical work.
      【Key words】 Negative pressure combined with ureteroscopy; Percutaneous nephrolithotomy (PCNL); Kidneycalculi; Ureteral calcili; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2021.20.032基金项目：云南省应用基础(昆医联合专项)面上项目(编号：2019FE001-226)