【摘要】：目的：綜合評價經(jīng)輸尿管軟鏡取石術（FURL)與經(jīng)皮腎鏡取石術(PCNL)在腎結石治療方面的安全性、療效。通過結石清除率、手術時間、住院時間、手術并發(fā)癥等方面的分析，從而對臨床上腎結石的治療起到一定的指導作用。 方法：計算機檢索：Pubmed，CNKI，ScienceDirect，Ovid，維普數(shù)據(jù)庫，CBMdisc，萬方醫(yī)學網(wǎng)，Medline，Springer等相關的數(shù)據(jù)庫，手工檢索已經(jīng)發(fā)表的運用經(jīng)輸尿管軟鏡取石術（flexible ureteroscope lithtripsy），經(jīng)皮腎鏡取石術（percutaneous nephrolithotomy）治療腎結石的國內外文獻，并追查相關納入文獻的參考文獻，使用Revman5.2軟件完成相關手術指標的Meta分析，采用比值比（OR值），加權均數(shù)差（WMD）和95%置信區(qū)間（95%CI）進行療效的評價，運用egger檢測發(fā)表偏倚，應用敏感性分析分析結論的穩(wěn)定性，最后對分析結果進行整理并發(fā)表。 結果：檢索后，共有11篇符合標準的文獻納入此次Meta分析，中文2篇，英文9篇，共1095例患者，方法學質量均為B級。Meta分析結果顯示：經(jīng)輸尿管軟鏡取石術組的總的結石清除率未達到經(jīng)皮腎鏡取石術組的療效。OR值等于0.64,95%置信區(qū)間為（0.44，0.94），P=0.02。在≤2cm的結石清除率方面經(jīng)輸尿管軟鏡取石術組低于經(jīng)皮腎鏡取石術組OR值等于0.64，95%的置信區(qū)間為（0.42，0.98），P=0.01。而在＞2cm的結石清除率方面差異則無統(tǒng)計學意義OR值等于0.51，95%置信區(qū)間為（0.17,1.50），P=0.22。經(jīng)皮腎鏡取石術組在手術時間上優(yōu)于經(jīng)輸尿管軟鏡取石術組，加權均數(shù)差等于17.06，95%的置信區(qū)間為（2.94，31.18），P=0.02。經(jīng)輸尿管軟鏡取石術組在住院時間上優(yōu)于經(jīng)皮腎鏡取石術組，標準化均數(shù)差為-1.29，95%置信區(qū)間為(-1.71，-0.87)，P＜0.00001。手術總并發(fā)癥發(fā)生率OR值0.47，95%的置信區(qū)間（0.30，0.73），P=0.0008。輸血率OR值0.14，95%的置信區(qū)間（0.03，0.63），P=0.01。經(jīng)輸尿管軟鏡取石術組與經(jīng)皮腎鏡取石術組發(fā)熱差異無統(tǒng)計學意義OR值1.19，95%的置信區(qū)間（0.53，2.70），P=0.68。經(jīng)輸尿管軟鏡取石術與經(jīng)皮腎鏡取石術出血率差異無統(tǒng)計學意義OR值0.35，，95%的置信區(qū)間（0.09，1.42），P=0.29，總之，經(jīng)輸尿管軟鏡取石術組在手術并發(fā)癥方面優(yōu)于經(jīng)皮腎鏡取石術組。 結論： 兩種手術方式對腎結石治療方面相關療效比較分析結論如下： 1.經(jīng)輸尿管軟鏡取石術在處理腎結石時安全可靠，但總的結石清除率卻沒有取得經(jīng)皮腎鏡取石術的療效。 ①處理≤2cm的腎結石時，經(jīng)輸尿管軟鏡取石術的療效較低； ②處理＞2cm的腎結石時，經(jīng)輸尿管軟鏡取石術與經(jīng)皮腎鏡取石術兩者療效相當。 2.在手術時間上，經(jīng)皮腎鏡取石術用時短。 3.在住院時間、住院花費、手術并發(fā)癥上，經(jīng)輸尿管軟鏡取石術占有較大優(yōu)勢。
[Abstract]:Objective: to evaluate the safety and efficacy of (FURL) and (PCNL) in the treatment of renal calculi. Through the analysis of stone clearance rate, operation time, hospitalization time, surgical complications and so on, it can play a certain guiding role in the treatment of renal stones. Methods: computer retrieval: Pubmed,CNKI,ScienceDirect,Ovid, Weipu database, CBMdisc, Wafang medical network, Medline,Springer and other related databases, manual retrieval of published use of soft ureter lithotomy (flexible ureteroscope lithtripsy), The domestic and foreign literature of (percutaneous nephrolithotomy) in the treatment of renal calculi was carried out, and the references included in the literature were traced down. The Meta analysis of the relevant surgical indexes was completed by Revman5.2 software, and the ratio (OR value) was used. Weighted mean difference (WMD) and 95% confidence interval (95%CI) were used to evaluate the curative effect. Egger was used to detect the bias, and the stability of sensitivity analysis was used. Finally, the analysis results were sorted out and published. Results: after retrieval, a total of 11 articles were included in the Meta analysis, 2 in Chinese and 9 in English, with a total of 1095 patients. The results of meta-analysis showed that the total stone clearance rate of the group was not as good as that of the group. The OR value was equal to 0.64, and the 95% confidence interval was (0.44, 0.94), P 鈮

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