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目的:对体外冲击波碎石术(ESWL)、输尿管镜碎石术(URS)、经皮肾镜碎石取石术(PCNL)治疗输尿管结石的有效性及安全性进行比较。方法:检索关于输尿管结石治疗的随机对照试验研究文献,数据库包括MEDLINE、EMBASE、Cochrane Library和中国生物医学文摘数据库(CBMDisc)等文摘数据库以及PUBMED、中国期刊全文数据库(CNKI)及维普中文期刊数据库(CQVIP)等全文数据库,按预设的标准筛选纳入研究,对文献质量进行严格评价和资料提取后,采用RevMan5.1软件进行Meta分析。结果:共有15个研究符合纳入标准。Meta分析显示:对于输尿管下段结石,URS组较ESWL组有较高的结石清除率及较低的重复治疗率(P<0.01),而在术后并发症及手术时间方面无明显差异(P>0.05);对于输尿管上段结石,ESWL组与URS组在结石清除率、术后并发症及重复治疗率方面均无显著差异(P>0.05),ESWL组平均治疗时间较URS组短(P<0.01);URS组与PCNL组治疗上段结石的对比分析显示PCNL组在结石清除率方面较URS组高(P<0.01),两组在术后并发症、平均手术时间及重复治疗方面无明显差异(P>0.05)。结论:对于输尿管下段结石的治疗,URS与ESWL相比有结石清除率高及较低的重复治疗率等优点,值得推荐;而对于输尿管上段结石的微创治疗方式的选择则需要进一步分析研究来指导临床实践。
Objective: To compare the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URS) and percutaneous nephrolithotomy (PCNL) in the treatment of ureteral calculi. Methods: A randomized controlled trial on the treatment of ureteral calculi was searched. The database includes abstracts databases such as MEDLINE, EMBASE, Cochrane Library and CBMDisc, as well as PUBMED, CNKI and VIP Chinese Periodicals Database CQVIP), and other full-text databases. According to the pre-set criteria, the results were screened and included in the study. After rigorous evaluation of the quality of the literature and data extraction, Meta-analysis was performed using RevMan5.1 software. Results: A total of 15 studies met the inclusion criteria. Meta-analysis showed that for the lower ureteral calculi, the URS group had a higher rate of stone removal and a lower rate of repeat treatment (P <0.01) than ESWL group, but no significant difference in postoperative complications and operation time (P> 0.05). For upper ureteral calculi, ESWL group and URS group had no significant difference in stone clearance rate, postoperative complication and repeat treatment rate (P> 0.05), but the average duration of treatment in ESWL group was shorter than that in URS group (P <0.01) ). The comparison of URS group and PCNL group in the treatment of upper calculus showed that PCNL group had higher stone clearance rate than URS group (P <0.01). There was no significant difference between the two groups in postoperative complications, average operation time and repeated treatment P> 0.05). Conclusions: URS is recommendable for the treatment of lower ureteral calculi compared with ESWL, and is recommended for minimally invasive treatment of upper ureteral calculi, and further analysis is needed Guiding clinical practice.