本文選題：腎結(jié)石　切入點(diǎn)：鈥激光　出處：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 應(yīng)用Meta分析方法比較鈥激光碎石術(shù)(Holmium laser lithotripsy, HL)與氣壓彈道碎石術(shù)(Pneumatic lithotripsy, PL)兩種碎石術(shù)在微創(chuàng)經(jīng)皮腎鏡碎石術(shù)(Minimally invasive percutaneous nephrolithotomy lithotripsy, MPCNL)中治療腎結(jié)石的優(yōu)缺點(diǎn),評(píng)估兩種碎石術(shù)的安全性和有效性,為經(jīng)皮腎鏡碎石術(shù)治療腎結(jié)石提供臨床治療證據(jù),為臨床醫(yī)師在手術(shù)方式的選擇上提供可靠的循證學(xué)證據(jù)。 方法 計(jì)算機(jī)檢索Pubmed、Cochrane library、SpringerLink、Embase、中國(guó)知網(wǎng)、維普數(shù)據(jù)庫、萬方醫(yī)學(xué)等中英文數(shù)據(jù)庫,搜集關(guān)于微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL與PL治療腎結(jié)石的隨機(jī)對(duì)照研究。檢索時(shí)間范圍設(shè)定為從建庫至2013年10月31日。兩名研究者對(duì)符合納入標(biāo)準(zhǔn)的文獻(xiàn)數(shù)據(jù)進(jìn)行獨(dú)立提取。試驗(yàn)采用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具進(jìn)行評(píng)價(jià)。納入數(shù)據(jù)通過RevMan5.0軟件進(jìn)行Meta分析。觀察指標(biāo)包括：1)碎石手術(shù)時(shí)間；2)工期治療結(jié)石排凈率；3)Ⅱ期治療結(jié)石排凈率；4)臨床并發(fā)癥；5)術(shù)中出血量；6)術(shù)后住院時(shí)間；7)結(jié)石排凈時(shí)間。 結(jié)果 按照嚴(yán)格的文獻(xiàn)納入標(biāo)準(zhǔn),最終納入臨床隨機(jī)對(duì)照研究的文獻(xiàn)共有7篇,總共納入870例患者,鈥激光碎石術(shù)組437例,氣壓彈道碎石術(shù)組433例。Meta分析結(jié)果示： (1)碎石手術(shù)時(shí)間的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得TotalWMD=-13.79,95%CI (-18.06,-9.51), Z=6.32, P=0.00001,兩組在碎石手術(shù)時(shí)間方面的差異有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組的碎石手術(shù)時(shí)間比PL組短。 (2)Ⅰ期治療結(jié)石排凈率的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.13,95%CI(1.05,1.22), Z=3.15, P=0.002,兩組的Ⅰ期治療結(jié)石排凈率有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組較PL組Ⅰ期治療結(jié)石排凈率高。 (3)Ⅱ期治療結(jié)石排凈率的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.11,95%CI(0.98,1.26), Z=1.70, P=0.09,兩組的Ⅱ期治療結(jié)石排凈率有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組較PL組Ⅱ期治療結(jié)石排凈率高。 (4)臨床并發(fā)癥發(fā)生率的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=-0.41,95%CI (0.22,0.73), Z=3.00,P=0.003,兩組在臨床并發(fā)癥發(fā)生率方面的差異有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組的臨床并發(fā)癥發(fā)生率比PL組低。 (5)術(shù)中出血量的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得TotalWMD=-24.41,95%CI (-26.2,-22.55), Z=25.72, P0.00001,兩組術(shù)中出血量方面的差異有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組的術(shù)中出血量比PL組少。 (6)術(shù)后住院時(shí)間的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得TotalWMD=-2.14,95%CI (-2.64,-1.64), Z=8.40, P 0.00001,兩組術(shù)后住院時(shí)間的差異有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組的術(shù)后住院時(shí)間比PL組短。 (7)結(jié)石排凈時(shí)間的比較：經(jīng)RevMan5.0軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得TotalWMD=-11.00,95%CI-12.28,-9.72), Z=16.85, P0.00001,兩組結(jié)石排凈時(shí)間的差異有統(tǒng)計(jì)學(xué)意義,微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中HL組的結(jié)石排凈時(shí)間比PL組短。 結(jié)論 通過Meta分析表明兩種碎石術(shù)在微創(chuàng)經(jīng)皮腎鏡碎石術(shù)中治療腎結(jié)石相比較有以下特點(diǎn)： 1、鈥激光碎石術(shù)的碎石手術(shù)時(shí)間較氣壓彈道碎石術(shù)的碎石手術(shù)時(shí)間短。 2、鈥激光碎石術(shù)較氣壓彈道碎石術(shù)Ⅰ、Ⅱ期治療結(jié)石排凈率高。 3、鈥激光碎石術(shù)的結(jié)石排凈時(shí)間比氣壓彈道碎石術(shù)組短。 4、鈥激光碎石術(shù)的術(shù)中出血量較氣壓彈道碎石術(shù)少。 5、鈥激光碎石術(shù)的臨床并發(fā)癥發(fā)生率比氣壓彈道碎石術(shù)組低。 6、鈥激光碎石術(shù)的術(shù)后住院時(shí)間比氣壓彈道碎石術(shù)組短。
[Abstract]:objective
Application of Meta analysis method comparison of holmium laser lithotripsy (Holmium laser lithotripsy, HL) and pneumatic lithotripsy (Pneumatic lithotripsy PL) two lithotripsy in minimally invasive percutaneous nephrolithotomy (Minimally invasive percutaneous nephrolithotomy lithotripsy, MPCNL) the advantages and disadvantages in the treatment of renal calculi and to evaluate the safety and efficacy of lithotripsy for two. Percutaneous nephrolithotomy in treatment of renal calculi provide clinical evidence for clinicians to provide reliable evidence-based medicine in the choice of surgical approach.
Method
Computer retrieval Pubmed, Cochrane library, SpringerLink, Embase, Chinese CNKI, VIP database, Wanfang database and English, collecting randomized controlled study of HL and PL percutaneous nephrolithotomy in treatment of renal calculi by minimally invasive. The retrieval time range is set from the database to October 31, 2013. Two researchers independently to extract in accordance with the inclusion criteria of literature data. In this experiment, the Cochrane collaboration bias risk assessment tool to evaluate. Included in the Meta data were analyzed by RevMan5.0 analysis software. The observation indexes include: 1) gravel operation time; 2) the duration of treatment of stone clearance rate; 3) phase II treatment of stone clearance rate; 4) clinical complications 5); bleeding; 6) hospitalization time after operation; 7) the lithagogue time.
Result
A total of 7 articles were included in the randomized controlled clinical trials, including 870 patients, 437 holmium laser lithotripsy group and 433 pneumatic ballistic lithotripsy group. The results of.Meta analysis showed that:
(1) comparison: gravel operation time is analyzed by RevMan5.0 software with data of TotalWMD=-13.79,95%CI (-18.06, -9.51), Z=6.32, P=0.00001, there was significant difference in the operation time of the two groups of gravel, gravel operation time of HL group after minimally invasive percutaneous nephrolithotomy in shorter than the PL group.
(2)鈪犳湡娌葷枟緇撶煶鎺掑噣鐜囩殑姣旇緝錛氱粡RevMan5.0杞歡緇熻鍒嗘瀽鍚堝茍鏁版嵁鍚庡緱RR=1.13,95%CI(1.05,1.22), Z=3.15, P=0.002,涓ょ粍鐨勨厾鏈熸不鐤楃粨鐭蟲帓鍑，

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