系统评价输尿管镜碎石术联合阻石网篮治疗上段输尿管结石的价值

Value of ureteroscopic lithotripsy combined with ntrap in treatment of upper urethral calculi：a Meta analysis

摘要:

目的：系统评价输尿管镜碎石术联合阻石网篮治疗输尿管上段结石的有效性及安全性。方法：计算机检索PubMed、Cochrane library、EMBASE、万方、中国知网全文数据库（CNKI）在线数据库，纳入输尿管镜下碎石术（ureteroscopic litho-tripsy，URL）联合NTrap治疗上段输尿管结石的随机对照研究及病例对照研究，文献的方法学质量评价及相关数据的提取由2名评价员独立完成，采用RevMan 5.0软件对终点数据进行分析。结果：共纳入2个随机对照研究及2个病例对照研究，共682例。Meta分析结果表明，URL联合阻石网篮较单独使用URL治疗输尿管上段结石的结石清除率明显提高（OR=4.28，95%CI=2.51～7.28，P＝0.000），结石移位率及辅助碎石率明显降低（OR=0.09，95%CI=0.01～0.62，P=0.010；OR=0.18，95%CI=0.05~0.67，P=0.010），平均手术时间差异无统计学意义（WMD=-0.09，95%CI=-10.25～10.06，P=0.990）。结论：URL联合阻石网篮治疗输尿管上段结石能明显提高结石清除率，有效降低结石移位率及辅助碎石率。

Abstract:

Objective：To systematically review the effectiveness and safety of ureteroscopic lithotripsy combined with ntrap for upper urethral calculi. Methods：All randomized clinical trials and case-controlled studies of ntrap during ureteroscopic lithotripsy（URL） for upper urethral calculi were identified with PubMed，Cochrane Librily，Embase，WangFang and CNKI. Quality assessments of litera－tures and data extraction were independently performed by two reviewers. Meta analysis was performed with Revman 5.0. Results：Two randomized trails and 2 case-controlled studies involving 682 patients were collected. Meta-analysis demonstrated that：ntrap group demonstrated a significant advantage over control group in terms of calculi clearance rate（OR=4.28，95%CI=2.51 to 7.28，P=0.000）. Incidences of calculi migration and auxiliary lithotripsy were significantly lower in ntrap group than in control group（OR=0.09，95%CI=0.01 to 0.62，P=0.01；OR=0.18，95%CI=0.05 to 0.67，P=0.010）. There was no statistical difference in mean operation time between the two groups（WMD=-0.09，95%CI=-10.25 to 10.06，P=0.990）. Conclusions：URL combined with ntrap for upper urethral calculi had higher calculi clearance rate，lower incidence of calculi migration and auxiliary lithotripsy than URL without ntrap.