体外冲击波和输尿管镜治疗输尿管结石疗效评价的Meta分析
The Meta analysis of the effect of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of urethral stone
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摘要: 目的: 系统评价体外冲击波和输尿管镜治疗输尿管结石的疗效。方法: 计算机检索 PubMed、EMbase、BIOSIS、International Pharmaceutical Abstracts,并检索Cochrane 图书馆对照试验注册库(2012 年第 9 期)及中国期刊全文数据库(1995年1月至2012年9月),同时检索搜集重要学术会议论文集,系统收集体外冲击波和输尿管镜治疗输尿管结石的随机对照试验。检索时间为1990年1月至2012年9月。由2名评价者共同评价纳入研究质量并提取资料,合并同质研究进行 Meta 分析,采用Revman 5.1软件完成资料分析。结果: 纳入9个研究,共1 399例输尿管结石患者。Meta分析结果显示,输尿管镜腔内碎石(URS)治疗结石在无石率方面优于体外冲击波碎石(ESWL)[OR=0.29,95%CI(0.14,0.57),P<0.01]且ESWL术后再次治疗率高于URS[OR=8.07,95%CI(5.23,12.46),P<0.01]。但URS术后需辅助治疗率要高于ESWL[OR=0.29,95%CI(0.13,0.62),I2=70%,P<0.01]。操作相关并发症URS较ESWL高[OR=0.42,95%CI(0.21,0.84),P=0.01],但URS术后不适症状较ESWL低[OR=0.24,95%CI(0.12,0.50),P<0.01,I2=0%]。ESWL住院时间短于URS[OR=-2.55,95%CI(-3.24,-1.86),P<0.01]。结论: 针对输尿管结石患者采取何种治疗方式为最优,可根据各家临床中心现有设备及患者结石的位置、大小以及有无合并症等综合判断。对于治疗方式的选择,仍需更多、更进一步的随机对照试验来支持验证。Abstract: Objective: To evaluate the effects of the extracorporeal shock wave lithotripsy(ESWL) and ureteroscopy(URS) in the treatment of urethral stone.Methods: The data of the randomized controlled trials of ESWL and ureteroscopy in the treatment of urethral stone from the Cochrane Central Register of Controlled Trials(CENTRAL in The Cochrane Library Issue 9,2012),CNKI,PubMed,EMbase,BIOSIS,International Pharmaceutical Abstracts,reference lists of articles and abstracts from conference proceedings were collected from Mon 1990 to Sep 2012,and which was evaluated and analyzed by two authors using RevMan5.1 software.Results: Nine randomized controlled trials(1399 patients) were investigated.The results of meta-analysis showed that the stone-free rate of URS was better than that of ESWL[OR=0.29,95%CI(0.14,0.57)(P<0.01)],but the re-treatment rate of ESWL after operation was higher than that of URS[OR=8.07,95%CI(5.23,12.46)(P<0.01)].The auxiliary treatment rate of URS after operation was higher than that of ESWL[OR=0.29,95%CI(0.13,0.62),I2=70%)(P<0.01)].The procedure-related complications of URS were higher than that of ESWL[OR=0.42,95%CI(0.21,0.84)(P=0.01)],but its post-operation complications were lower[OR=0.24,95%CI(0.12,0.50)(P<0.01),I2=0%].The length of hospital stay of ESWL was shorter than that of URS[OR=-2.55,95%CI(-3.24,1.86)(P<0.01)].Conclusions: The choice of treatment for urethral stone should accord to the existing equipment,location and size of urethral stone,and which need the further verification of randomized controlled trials.
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Key words:
- ureteral stone /
- ureteroscope /
- extracorporeal shock wave lithotripsy /
- Meta analysis
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