經輸尿管軟鏡取石術與經皮腎鏡取石術治療腎結石的有效性和安全性的系統評價_《中國循證醫學雜志》

作者：

牛超 , 廖邦華 , 羅德毅 ,  王坤杰

四川大學華西醫院泌尿外科（成都 610041）;

關鍵詞：

腎結石經輸尿管軟鏡取石術經皮腎鏡取石術系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130153

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目的　系統評價經輸尿管軟鏡取石術與經皮腎鏡取石術治療腎結石的有效性和安全性。
方法　計算機檢索MEDLINE、EMbase、The Cochrane Library、CNKI、CBM、VIP及WanFang Data（1990.1～2012.8），全面收集有關經輸尿管軟鏡取石術和經皮腎鏡取石術比較治療腎結石的臨床試驗。由兩位研究者獨立進行文獻篩選、資料提取和評價納入研究的方法學質量后，采用RevMan 5.1軟件進行Meta分析。
結果　納入8篇研究，均為非隨機對照試驗，共計536例患者。Meta分析結果顯示：經輸尿管軟鏡取石術的結石清除率低于經皮腎鏡取石術［OR=0.26，95%CI（0.15，0.46）］，而在術后發熱［OR=0.1，95%CI（0.42，3.35）］、是否輸血［OR=0.17，95%CI（0.03，1.00）］、住院時間［MD= –1.25，95%CI（–1.54，–0.96）］方面則優于經皮腎鏡取石術。
結論　現有證據顯示，在結石清除率方面，經輸尿管軟鏡取石術低于經皮腎鏡取石術，而在并發癥、住院時間、醫療費用方面，經輸尿管軟鏡取石術則優于經皮腎鏡取石術。

引用本文： 牛超,廖邦華,羅德毅,王坤杰. 經輸尿管軟鏡取石術與經皮腎鏡取石術治療腎結石的有效性和安全性的系統評價. 中國循證醫學雜志, 2013, 13(7): 868-874. doi: 10.7507/1672-2531.20130153 復制

1.	吳孟超, 吳在德, 主編. 黃家駟外科學. 第7版. 北京: 人民衛生出版社, 2008: 1432-1980.
2.	石美鑫, 主編. 實用外科學. 第2版. 北京: 人民衛生出版社, 2005: 2405-2410.
3.	岐宏政, 沈鵬飛, 劉勇, 等. 腎鏡取石術與開放手術治療腎結石的系統評價. 中華腔鏡泌尿外科雜志(電子版), 2009, 3(5): 382-388.
4.	程躍, 劉冠琳, 輸尿管軟鏡治療上尿路結石的現狀與展望. 現代實用醫學, 2012, 24(6): 603-606.
5.	劉鳴, 主編. 系統評價、META-分析設計與實驗方法. 第1版. 北京: 人民衛生出版社, 2011: 98-117.
6.	Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7.	Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8.	Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9.	Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10.	Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11.	Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12.	高小峰, 周鐵, 陳書尚, 等. 輸尿管軟鏡碎石與微創經皮腎取石術治療腎盞結石的對比研究. 中華腔鏡泌尿外科雜志, 2007, 1(2): 69-72.
13.	施小東, 程躍, 邱中笑, 等. 電子輸尿管軟鏡碎石術治療腎結石療效觀察. 現代實用醫學, 2012, 22(9): 1018-1019.
14.	Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15.	Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16.	Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17.	Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18.	Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19.	Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20.	Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21.	El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22.	馬建偉, 程躍. 輸尿管軟鏡治療上尿路結石新進展. 臨床泌尿外科雜志, 2012, 27(5): 398-400.
23.	Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

1. 吳孟超, 吳在德, 主編. 黃家駟外科學. 第7版. 北京: 人民衛生出版社, 2008: 1432-1980.
2. 石美鑫, 主編. 實用外科學. 第2版. 北京: 人民衛生出版社, 2005: 2405-2410.
3. 岐宏政, 沈鵬飛, 劉勇, 等. 腎鏡取石術與開放手術治療腎結石的系統評價. 中華腔鏡泌尿外科雜志(電子版), 2009, 3(5): 382-388.
4. 程躍, 劉冠琳, 輸尿管軟鏡治療上尿路結石的現狀與展望. 現代實用醫學, 2012, 24(6): 603-606.
5. 劉鳴, 主編. 系統評價、META-分析設計與實驗方法. 第1版. 北京: 人民衛生出版社, 2011: 98-117.
6. Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7. Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8. Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9. Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10. Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11. Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12. 高小峰, 周鐵, 陳書尚, 等. 輸尿管軟鏡碎石與微創經皮腎取石術治療腎盞結石的對比研究. 中華腔鏡泌尿外科雜志, 2007, 1(2): 69-72.
13. 施小東, 程躍, 邱中笑, 等. 電子輸尿管軟鏡碎石術治療腎結石療效觀察. 現代實用醫學, 2012, 22(9): 1018-1019.
14. Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15. Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16. Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17. Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18. Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19. Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20. Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21. El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22. 馬建偉, 程躍. 輸尿管軟鏡治療上尿路結石新進展. 臨床泌尿外科雜志, 2012, 27(5): 398-400.
23. Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

《中國循證醫學雜志》

經輸尿管軟鏡取石術與經皮腎鏡取石術治療腎結石的有效性和安全性的系統評價

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《中國循證醫學雜志》

經輸尿管軟鏡取石術與經皮腎鏡取石術治療腎結石的有效性和安全性的系統評價

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