【摘要】 目的系统评价微通道经皮肾镜取石术(MPCNL)与标准通道经皮肾镜取石术(SPCNL)治疗肾结石的临床疗效与安全性。方法计算机检索Pub Med、Cochrane Liabrary、EMbase、CNKI、维普数据库,检索时限从2001年1月1日至2013年2月1日。筛选两种通道经皮肾镜取石术(PCNL)治疗肾结石的随机对照试验(RCT)及非随机对照试验(non-RCT)并进行文献质量评价,采用RevM an5.1软件进行统计学处理。结果共纳入6个RCT及2个non-RCT研究,1163例患者。结果显示:两种通道处理鹿角型结石的清除率无显著差别[OR=0.93,95%CI(0.54,1.59),P=0.79];MPCNL处理肾盏多发性结石的清除率高于SPCNL[OR=2.01,95%CI(1.19,3.38),P=0.009],但其处理单纯肾盂结石的清除率低于SPCNL[OR=0.45,95%CI(0.25,0.79),P=0.006]。在手术时间方面,SPCNL处理3种类型结石均优于MPCNL,分别为[MD=22.7、9.77、13.04,95%CI(17.73,27.72)、(7.12,12.42)、(10.23,15.85),P<0.01、<0.01、<0.01]。在发热方面,两种通道手术无明显差别[OR=0.92,95%CI(0.61,1.38),P=0.68],但在手术明显出血的发生率方面,MPCNL低于SPCNL[OR=0.32,95%CI(0.16,0.61),P=0.0007]。结论 MPCNL与SPCNL在处理不同类型结石各自有优点,MPCNL适合处理肾盏多发结石及较小的肾盂结石,SPCNL适用于治疗单纯较大的肾盂结石。更多还原

【Abstract】 Objective To evaluate the effect and safety of mini percutaneous nephrolithotomy(MPCNL) and standard percutaneous nephrolithotomy(SPCNL) in the treatment of renal calculi. Methods Such databases as Pub Med, the Cochrane Liabrary, EMbase and CNKI were searched for the randomized controlled trial(RCT) and non randomized controlled trials(non-RCT) of MPCNL and SPCNL from January1, 2001 to February 1, 2013. The quality of literature was evaluated and the Meta-analyses were performed with RevM an5.1 software. Results Six RCTs and two non-RCTs were included. There was no significant difference between the two groups in the clearance rate of renal staghorn calculi [OR=0.93, 95% CI(0.54,0.54), P=0.79]. In the clearance rate of calyces multiple calculi, MPCNL was better than SPCNL [OR=2.01,95% CI(1.19, 1.19), P=0.009], but was worser than SPCNL in the clearance rate of simple renal pelvis calculi [OR=0.45, 95% CI(0.25, 0.25), P=0.006]. In the operation time of three kinds of stone, SPCNL was better than MPCNL, respectively [MD=22.7, 9.77, 13.04, 95%CI(17.73, 27.72),(7.12,12.42),(10.23,15.85),P <0.01, <0.01, <0.01]. There was no significant difference between two kinds of channel operation in terms of heating [OR=0.92, 95%CI(0.61, 0.61), P=0.68]. Howere, MPCNL was better than SPCNL in theincidence of evident bleeding [OR=0.32, 95%CI(0.16, 0.61), P=0.0007]. Conclusions MPCNL and SPCNL have their own advantages on dealing with different types of stones. MPCNL is suitable for calyces multiple calculi, while SPCNL is suitable for large pelvic stones.更多还原