硕通镜碎石术与输尿管镜碎石术治疗尿路结石有效性和安全性的Meta分析

Efficacy and safety of negative pressure combined with ureteroscopy and ureteroscope lithotripsy in treatment of urolithiasis: a Meta-analysis

摘要:

目的 评价硕通镜和输尿管镜治疗尿路结石的有效性和安全性，并进行Meta分析。方法 计算机检索英文数据库PubMed、Embase、The Cochrane Library和中文数据库CNKI、VIP、CBM及WanFang Data（检索时间为建库至2020年2月），收集有关比较硕通镜和输尿管镜治疗尿路结石的临床试验。由两名研究者独立进行文献筛选、数据提取和评价纳入文献的方法质量学，使用Review Manager 5.3软件进行Meta分析。结果 该研究共纳入8篇研究，总样本量为901例。硕通镜组术后1个月结石清除率较输尿管镜组高（O = 2.72，95%CI：1.78～4.13，P < 0.05），并发症发生率较输尿管镜组低（O = 0.33，95%CI：0.22～0.50，P < 0.05）；两组置鞘成功率（O = 0.73，95%CI：0.25～2.10）、手术时间（MD = -3.14，95%CI：-11.78～5.50）和术后住院时间（MD = -0.02，95%CI：-0.13～0.09）比较，差异均无统计学意义（P > 0.05）。结论 硕通镜碎石术相对于传统输尿管镜而言，是一种能使患者受益的手术方式，拥有更高的结石清除率与较低的并发症发生率，但手术时间和住院时间等方面还需要更多高质量的试验予以验证，以期为临床提供参考。

Abstract:

Objective A Meta-analysis of the efficacy and safety of negative pressure combined with ureteroscopy (SOTN) and ureteroscope lithotripsy (URL) in treatment of urolithiasis.Methods PubMed, Embase, The Cochrane Library, CNKI, VIP, CBM, and Wanfang Data were searched to collect the clinical trials on the comparative treatment of urolithiasis by SOTN and URL from inception to Feb 2020. After literature selection, data extraction and evaluation by two researchers independently, the Meta-analysis was conducted by Review Manager 5.3 software.Results Eight studies were included in this study, with a total sample size of 901. There is a higher stone free rate (O = 2.72, 95%CI: 1.78~4.13, P < 0.05) and lower incidence of complications (O = 0.33, 95%CI: 0.22~0.50, P < 0.05) of SOTN compared with URL. The difference between the two groups has no significant in the insertion success rate (O = 0.73, 95%CI: 0.25~2.10, P > 0.05), operation time (MD = -3.14, 95%CI: -11.78~5.50, P > 0.05) and postoperative hospital stay (MD = -0.02, 95%CI: -0.13~0.09, P > 0.05).Conclusion Compared with the traditional ureteroscope, SOTN is a kind of operation that can benefit the patients. It has a higher stone free rate and a lower incidence of complications. However, more high-quality experiments are needed to verify such aspects as operation time and hospital stay, so as to provide clinical reference.