腔内超声造影与常规超声引导经皮肾镜取石术治疗肾结石的Meta分析

Meta-analysis of intracavitary contrast-enhanced ultrasound and conventional ultrasound-guided PCNL for treatment of kidney stones

摘要:

目的 系统评价腔内超声造影（ICCEUS）与常规超声（US）引导经皮肾镜取石术（PCNL）治疗肾结石的临床效果及安全性。方法 检索PubMed、Embase、The Cochrane Library、中国知网（CNKI）、维普（VIP）、中国生物医学文献服务系统（SinoMed）和万方（Wanfang Data）等数据库，收集、筛选并提取有关比较ICCEUS与US引导PCNL的临床研究数据。采用RevMan 5.3软件进行Meta分析。结果 最终7篇文献被纳入研究，总样本量为696例。ICCEUS-PCNL组一次穿刺成功率（OR＾ = 4.52，95%CI：2.99～6.82）和结石清除率（OR＾ = 2.32，95%CI：1.15～4.68）均较US-PCNL组高，并发症发生率（OR＾ = 0.49，95%CI：0.30～0.80）较US-PCNL组低，血红蛋白下降值（MD = -6.94，95%CI：-9.72～-4.16）和术中出血量（MD = -44.06，95%CI：-73.11～-15.02）较US-PCNL组少，手术时间（MD = -20.86，95CI%：-40.28～-1.44）和住院时间（MD = -2.38，95%CI：-4.15～-0.60）较US-PCNL组短。结论 与US-PCNL相比，ICCEUS-PCNL能提高PCNL的一次穿刺成功率及结石清除率，并且可缩短手术时间及住院时间，减少血红蛋白下降值/术中出血量，降低并发症发生率。值得临床推广应用。

Abstract:

Objective To systematically assess the effectiveness and safety of intracavitary contrast-enhanced ultrasound (ICCEUS) and conventional ultrasound (US)-guided PCNL for the treatment of kidney stones.Methods A literature search in PubMed, The Cochrane Library, Embase, CNKI, VIP, SinoMed and Wanfang Data was performed to collect, screen and extract clinical research data comparing contrast-enhanced ultrasound with conventional ultrasound-guided PCNL. Meta-analysis was performed by RevMan 5.3 software.Results 7 literatures were included in this study with a total sample size of 696 cases. ICCEUS-PCNL group had higher success rate of single puncture (OR＾ = 4.52, 95%CI: 2.99 ~ 6.82) and stone clearance rate (OR＾ = 2.32, 95%CI: 1.15 ~ 4.68) than US-PCNL group. The complication rate (OR＾ = 0.49, 95%CI: 0.30 ~ 0.80) was lower than US-PCNL group. The hemoglobin loss value (MD = -6.94, 95%CI: -9.72 ~ -4.16) and intraoperative blood loss (MD = -44.06, 95%CI: -73.11 ~ -15.02) were less than US-PCNL group. The operation time (MD = -20.86, 95CI%: -40.28 ~ -1.44) and hospitalization time (MD = -2.38, 95%CI: -4.15 ~ -0.60) were shorter than US-PCNL group.Conclusion Compared with US-PCNL, this Meta-analysis shows that ICCEUS-PCNL can improve the success rate of single puncture and stone clearance rate, shorten the operation time and hospitalization time, and reduce the hemoglobin drop value/intraoperative blood loss and complication rates. It is worthy of clinical application.