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目的系统评价经皮肾镜取石术(PCNL)与输尿管镜碎石术(URL)治疗直径>1 cm的嵌顿性输尿管上段结石的有效性及安全性。方法计算机检索Pub Med、Cochrane图书馆、Embase、万方、中国知网全文数据库、维普数据库(从建库至2015年7月),纳入PCNL与URL治疗直径>1 cm的嵌顿性输尿管上段结石的随机对照试验(RCT),对纳入的研究进行质量评价,并提取有效数据,采用Rev Man 5.3软件进行Meta分析。结果最终纳入6篇文献,均为RCT,患者共487例。Meta分析结果表明,与URL组比较,PCNL组患者结石清除率提高[RR=1.20,95%CI(1.09,1.33),P=0.000 3],术后发热、输尿管穿孔发生率差异无统计学意义[RR=1.73,95%CI(0.43,7.00),P=0.45;RR=1.02,95%CI(0.11,9.37),P=0.99],术后显著血尿发生率更高[RR=1.99,95%CI(1.09,3.62),P=0.03],平均手术时间更长[WMD=30.03 min,95%CI(10.04,50.02)min,P=0.003],平均住院时间延长3.73 d[WMD=3.73 d,95%CI(3.02,4.44)d,P<0.000 01]。结论 PCNL能明显提高直径>1 cm的嵌顿性输尿管上段结石清除率,但平均手术时间及患者平均住院时间更长。
Objective To systematically evaluate the effectiveness and safety of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URL) in the treatment of incarcerated ureteral calculi with diameter> 1 cm. Methods We searched PubMed, Cochrane Library, Embase, Wanfang, CNKI Full Text Database and VIP database (from the database to July 2015). PCNL and URL were used to treat upper incarcerated ureteral calculi> 1 cm in diameter Randomized controlled trials (RCTs) to assess the quality of the included studies and to extract valid data for Meta-analysis using RevMan 5.3 software. The results were finally included in 6 articles, all RCT, a total of 487 patients. Meta-analysis showed that compared with the URL group, the stone clearance rate of patients with PCNL increased [RR = 1.20,95% CI (1.09,1.33), P = 0.0003], postoperative fever, the incidence of ureter perforation was not statistically significant RR = 1.02, 95% CI (0.11, 9.37), P = 0.99], and a significantly higher incidence of hematuria after surgery [RR = 1.73,95% CI 0.43,7.00, P = 0.45; RR = The mean length of stay was 3.73 d [WMD = 3.73 d (95% CI 10.04,50.02) min, P = 0.003], and the average length of stay was 3.73 d , 95% CI (3.02, 4.44) d, P <0.000 01]. Conclusion PCNL can significantly improve the clearance rate of upper ureteral calculi> 1 cm in diameter, but the average operation time and the average length of hospital stay are longer.