【摘要】 目的 评价逆行输尿管软镜碎石术（RIRS）、经皮肾镜碎石取石术（PCNL）和体外冲击波碎石术（ESWL）治疗肾下盏结石的有效性及安全性。方法 通过计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、维普及万方等数据库，收集2020年12月前上述3种方式治疗肾下盏结石的随机对照试验或回顾性病例对照试验，严格按照纳入与排除标准对文献进行筛选、数据提取和质量评价，采用Revman 5.3软件进行Meta分析。结果 共纳入16项研究，共计2 784例肾下盏结石患者。Meta分析结果显示，ESWL术后结石清除率明显低于RIRS和PCNL(OR=0.46,95%CI:0.34～0.63,P<0.05;OR=0.33,95%CI:0.26～0.43,P<0.05)。ESWL术后并发症发生率明显低于PCNL(OR=0.21,95%CI:0.15～0.29,P<0.05)；但ESWL与RIRS术后并发症发生率比较差异无统计学意义（OR=0.74,95%CI:0.50～1.09,P>0.05）。ESWL术后再次治疗率明显高于RIRS和PCNL(OR=14.03,95%CI:8.79～22.39,P<0.05;OR=20.62,95%CI:12.87～33.05,P<0.05)。结论 与PCNL、RIRS相比，ESWL在治疗肾下盏结石中有效性较低，表现为结石清除率低、再次治疗率高，术后并发症发生率比PCNL高。更多还原

【Abstract】 Objective To systematically review the efficacy and safety of retrograde intrarenal surgery(RIRS),percutaneous nephrolithotomy(PCNL) and extracorporeal shock wave lithotripsy(ESWL) in the treatment of lower pole renal stone(<3 cm). Methods Databases PubMed, Embase, the Cochrane library, and Web of Science were searched for randomized controlled trials and non-randomized controlled trials of RIRS, PCNL and ESWL in treatment of lower pole renal stone before 2020. After data extraction and literature quality evaluation, a meta analysis was performed using Revman 5.3software. Results A total of 16 studies were included, 8 randomized controlled trials and 8 retrospective case-control trials involving 2 784 patients. Meta-analysis results showed that the stone clearance rate of ESWL was significantly lower than that of PCNL and RIRS(OR=0.33, 95%CI: 0.26-0.43, P<0.05; OR=0.46, 95%CI: 0.34-0.63, P<0.05). Postoperative complication rate of ESWL was significantly lower than that of PCNL(OR=0.21, 95%CI: 0.15-0.29, P<0.05), but no significant difference between ESWL and RIRS(OR=0.74, 95% CI: 0.50-1.09, P>0.05). ESWL has a significantly higher re-treatment rate than PCNL and RIRS(OR=20.62, 95% CI: 12.87-33.05, P<0.05; OR=14.03, 95% CI: 8.79-22.39, P<0.05). Conclusion Compared with PCNL and RIRS, ESWL is less effective in the treatment of lower calyx stones, which is manifested by lower stone clearance rate, higher re-treatment rate, and higher incidence of postoperative complications than PCNL.更多还原