微通道和标准通道经皮肾镜碎石术中肾盂内压力、术后发热及手术效果比较的meta分析

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摘要目的通过进行微通道经皮肾镜取石术（MPCNL）与标准通道经皮肾镜取石术（SPCNL）治疗上尿路结石的系统评价，比较两种手术方式的安全性及手术效果。方法检索Pubmed、Cochrane Library、Embase、万方、中国知网以及维普数据库中有关经皮肾镜取石术治疗上尿路结石患者的随机对照试验，检索时限为建库起至2019年12月1日，由2 名评价者按照纳入与排除标准选择试验、提取资料后采用Revman 5.3 软件进行meta分析。结果本研究共纳入4 项随机对照试验，共计375 例患者。分析结果显示，MPCNL 组治疗过程中的肾盂内压力（RPP）高于SPCNL 组，差异有统计学意义（MD=10.38，95%CI：6.37～14.38，P＜0.000 01）；MPCNL 组的术后发热（POF）率高于SPCNL 组，差异有统计学意义（OR=2.43，95%CI：1.39～4.27，P=0.002）；MPCNL 组和SPCNL 组的手术时间比较，差异无统计学意义（MD=5.69，95%CI：-4.54～15.91，P=0.28）；MPCNL 组和SPCNL 组的清石率比较，差异无统计学意义（OR=1.06，95%CI：0.61～1.86，P=0.83）。结论 MPCNL 相比SPCNL 可以增加术中的RPP，同时使患者POF 率也相应增加，二者在手术效果如手术时间、清石率方面相当，所以MPCNL 术中检测RPP 对于确保患者安全、减少术后并发症具有重要意义。

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关键词 ：标准通道经皮肾镜取石术, 微通道经皮肾镜取石术, 肾盂内压力, 系统评价, meta分析

Abstract：Objective To systematically evaluate the safety and efficacy of surgery between mini-tract percutaneous nephrolithotomy(MPCNL)and standard-tract percutaneous nephrolithotomy(SPCNL)in the treatment of upper urinary tract calculi.Methods Pubmed,Cochrane Library,Embase,Wanfang,CNKI and VIP databases were searched for randomized controlled trials related to percutaneous nephrolithotomy for patients with upper urinary calculi from the establishment of the database to December 1,2019.Two evaluators selected the trials according to the inclusion and exclusion criteria,and the data were extracted and analyzed by Revman 5.3 software for meta analysis.Results Four randomized controlled trials were included in this study,with a total of 375 patients.The results showed that the renal pelvis pressure(RPP)in MPCNL group was higher than that in SPCNL group,and the difference was statistically significant(MD=10.38,95%CI: 6.37-14.38, P＜0.000 01).The postoperative fever(POF)rate in MPCNL group was higher than that in SPCNL group,the difference was statistically significant(OR=2.43,95%CI: 1.39-4.27, P=0.002).There was no significant difference in the operative time between the MPCNL group and the SPCNL group(MD=5.69,95%CI:-4.54-15.91, P=0.28).There was no significant difference in stone clearing rate between MPCNL group and SPCNL group(OR=1.06,95%CI: 0.61-1.86, P=0.83).Conclusion Compared with SPCNL,MPCNL can increase intraoperative RPP and the patients′ POF rate.The two have similar surgical effect such as operation time and stone clearing rate.Therefore,the intraoperative detection of RPP by MPCNL is of great significance to ensure patient safety and reduce postoperative complications.

Key words： Standard-tract percutaneous nephrolithotomy Mini-tract percutaneous nephrolithotomy Renal pelvis pressure Systematic review Meta analysis

收稿日期: 2021-04-02

通讯作者: 许振强（1966-），男，福建漳州人，主任医师，硕士生导师，研究方向：男科及泌尿系结石

作者简介: 万金平（1986-），男，江西抚州人，硕士，研究方向：泌尿系结石的微创治疗

引用本文:

万金平；林建贵；罗流涛；许振强. 微通道和标准通道经皮肾镜碎石术中肾盂内压力、术后发热及手术效果比较的meta分析[J]. 中国当代医药, 2022, 29(11): 20-23.
WAN Jinping LIN Jiangui LUO Liutao XU Zhenqiang▲. Comparison of renal pelvic pressure,postoperative fever and effect of surgery between mini and standard-tract percutaneous nephrolithotomy:a meta-analysis. 中国当代医药, 2022, 29(11): 20-23.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I11/20

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