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目的探讨开放手术与经皮肾镜取石术治疗鹿角形肾结石的安全性与有效性。方法计算机检索维普、万方、中国知网、Pub Med、Cochrane和EMbase数据库,查找所有比较开放手术和经皮肾镜取石术的随机对照试验(RCT),检索时间范围从2001年1月1日—2013年12月31日,按纳入和排除标准由两人分别独立进行RCT的筛选、提取和质量评价,应用Rev Man5.2进行meta分析。结果共纳入8个研究,共747例患者。Meta分析显示,在手术时间方面,开放手术长于经皮肾镜取石术[WMD=49.77,95%CI(22.47,77.08),P<0.01];在出血量方面,开放手术多于经皮肾镜取石术[WMD=89.81,95%CI(86.20,93.42),P<0.01];在术后住院时间方面,开放手术长于经皮肾镜取石术[WMD=5.34,95%CI(1.81,8.88),P<0.01];在结石清除率方面,开放手术与经皮肾镜取石术相比,差异无统计学意义[OR=0.64,95%CI(0.21,1.99),P>0.05];在并发症发生率方面,开放手术与经皮肾镜取石术相比显著增高[OR=2.13,95%CI(1.33,3.43),P<0.01]。结论两种治疗鹿角性肾结石的手术方法相比,经皮肾镜取石术在手术时间、出血量、术后住院时间和并发症发生率方面均优于开放手术。
Objective To investigate the safety and efficacy of open surgery and percutaneous nephrolithotomy in the treatment of antler kidney stones. Methods We searched the databases of VIP, Wanfang, CNKI, Pub Med, Cochrane and EMbase to find out all the randomized controlled trials (RCTs) comparing open surgery and percutaneous nephrolithotomy. The search time ranged from January 1, 2001 - On December 31, 2013, the screening, extraction and quality evaluation of RCT were independently performed by two individuals according to inclusion and exclusion criteria, and RevMan5.2 was used for meta-analysis. Results A total of 8 studies were included, with a total of 747 patients. Meta-analysis showed that in terms of operative time, open surgery was longer than percutaneous nephrolithotomy [WMD = 49.77, 95% CI (22.47, 77.08), P <0.01]; in terms of bleeding, more open surgery than percutaneous nephrolithotomy (WMD = 5.34, 95% CI (1.81, 8.88)). In the postoperative hospital stay, open surgery was longer than percutaneous nephrolithotomy [WMD = 5.34,95% CI , P <0.01]. There was no significant difference between open surgery and percutaneous nephrolithotomy in stone clearance rate [OR = 0.64, 95% CI (0.21, 1.99), P> 0.05] In the incidence of disease, the open surgery was significantly higher than that of percutaneous nephrolithotomy [OR = 2.13, 95% CI (1.33, 3.43, P <0.01]. Conclusion Compared with the surgical treatment of antler kidney stones, percutaneous nephrolithotomy is superior to open surgery in the aspects of operation time, blood loss, postoperative hospital stay and complication rate.