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目的系统评价经尿道输尿管镜碎石术治疗输尿管上段结石的安全性和有效性。方法计算机检索The Cochrane Library(2013年第3期)、PubMed(1966~2013.8)、EMbase(1990~2013.8)、CNKI(1949~2013.9)、CBM(1978~2013.9)、VIP(1989~2013.8)和WanFang Data(1990~2013.8),全面收集有关后腹腔镜输尿管切开取石术和经尿道输尿管镜碎石术比较治疗输尿管上段结石的随机对照试验(RCT)。由2位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量后,采用RevMan5.2软件进行Meta分析。结果共纳入16个RCT,1 410例患者,其中输尿管镜组747例,后腹腔镜组663例。Meta分析结果显示:输尿管镜组在手术成功率[OR=0.26,95%CI(0.14,0.51)]、3天结石清除率[OR=0.06,95%CI(0.03,0.11)]和1月结石清除率[OR=0.21,95%CI(0.08,0.53)]方面均低于后腹腔镜组,但在手术时间[MD=–22.35,95%CI(–35.29,–9.41)]、术后住院时间[MD=–1.84,95%CI(–3.44,–0.24)]方面优于后腹腔镜组。结论现有证据表明:对于输尿管上段结石,经尿道输尿管镜碎石术比后腹腔镜输尿管切开取石术手术时间及术后住院时间更短,但在手术成功率、清石率及并发症发生率等方面并无优势。
Objective To systematically evaluate the safety and effectiveness of transurethral ureteroscopic lithotripsy in the treatment of upper ureteral calculi. Methods The Cochrane Library (2013), PubMed (1966 ~ 2013.8), EMbase (1990 ~ 2013.8), CNKI (1949 ~ 2013.9), CBM (1978 ~ 2013.9), VIP (1989 ~ 2013.8) and WanFang Data (1990 ~ 2013.8) A comprehensive randomized controlled trial (RCT) was conducted for the comparison of retroperitoneal ureterolithotomy with transurethral ureteroscopic lithotripsy in the treatment of upper ureteral calculi. Two researchers independently screened the literature, extracted the data and evaluated the quality of the methodology included in the study. Meta-analysis was performed using RevMan5.2 software. Results A total of 16 RCTs and 1 410 patients were enrolled, of which 747 were ureteroscopy and 663 were retroperitoneal laparoscopy. The results of Meta analysis showed that the success rate of ureteroscopic surgery in the ureteroscopic group was significantly higher than that of the ureteral group (OR = 0.26, 95% CI 0.14, 0.51), stone removal rate 3 days (OR = 0.06,95% CI 0.03,0.11) (OR = 0.21, 95% CI (0.08, 0.53)] were lower than those in the retroperitoneal laparoscopic group at the time of operation [MD = -22.35,95% CI (-35.29, -9.41) Time [MD = -1.84, 95% CI (-3.44, -0.24)] was superior to the retroperitoneal laparoscopic group. Conclusion The available evidence shows that transurethral ureteroscopic lithotripsy is shorter than post-laparoscopic ureterolithotomy for shorter stones in upper ureteral calculi, but the success rate of operation, rate of clear stone and complication Rate and other aspects have no advantage.