Efficacy and safety of disposable ureteroscope and reusable ureteroscope in the treatment of upper urinary tract stones: a meta-analysis
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摘要: 目的 系统评价一次性输尿管软镜(single-use flexible ureteroscopes，su-fURS)与可重复使用输尿管软镜(reusable flexible ureteroscopy，ru-fURS)治疗上尿路结石的疗效与安全性。方法 系统性检索Pubmed、Embase、Cochrane Library、中国知网、万方、维普数据库中关于比较su-fURS与ru-fURS治疗上尿路结石的临床研究数据，检索时间均从建库至2023年4月。提取纳入研究的信息和数据，使用统计软件Review Manager 5.3进行meta分析。结果 共纳入16篇文献，包括2 121例患者，su-fURS组1 082例，ru-fURS组1 039例。结果显示，su-fURS与ru-fURS治疗上尿路结石，在碎石总有效率(OR＝1.17，95%CI：0.94~1.46，P＝0.16)、套石篮使用率(OR＝1.36，95%CI：0.82~2.26，P＝0.23)、术后住院时间(OR＝-0.04，95%CI：-0.15~0.06，P＝0.44)、术前双J管留置率(OR＝1.00，95%CI：0.78~1.27，P＝0.97)、术后ClavienⅠ~Ⅱ并发症发生率(OR＝1.12，95%CI：0.81~1.54，P＝0.49)方面差异无统计学意义。但su-fURS对肾下盏碎石有效率高于ru-fURS(OR＝2.61，95%CI：1.34~5.07，P＝0.005)。结论 su-fURS与ru-fURS治疗上尿路结石疗效及安全性相当，但su-fURS对肾下盏结石有更高的有效率。该结论尚需更多高质量研究进一步验证。
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关键词:
- 一次性输尿管软镜 /
- 可重复使用输尿管软镜 /
- 上尿路结石 /
- meta分析
Abstract: Objective To systematically review the efficacy and safety of single-use flexible ureteroscope (su-fURS) versus reusable flexible ureteroscope (ru-fURS) in the treatment of upper urinary tract stones.Methods We systematically searched clinical research data comparing su-fURS and ru-fURS in the treatment of upper urinary tract stones in Pubmed, Embase, Cochrane Library, CNKI, Wanfang and Weipu databases, from the establishment of the library to April 2023. Information and data from included studies were extracted and meta-analysis was performed using the statistical software Review Manager 5.3.Results A total of 16 articles were included, including 2 121 patients, 1 082 in the su-fURS group and 1 039 in the ru-fURS group. The results showed that there were no statistically significant differences between su-fURS and ru-fURS in the treatment of upper urinary tract stones in terms of the total effective rate of lithotripsy(OR=1.17, 95%CI: 0.94-1.46, P=0.16), the utilization rate of stone basket(OR=1.36, 95%CI: 0.82-2.26, P=0.23), postoperative hospital stay(OR=-0.04, 95%CI: -0.15-0.06, P=0.44), preoperative double J tube indwelling rate(OR=1.00, 95%CI: 0.78-1.27, P=0.97), or postoperative Clavien Ⅰ-Ⅱ complication rate(OR=1.12, 95%CI: 0.81-1.54, P=0.49). However, the efficiency of su-fURS for lower renal calyceal calculi was higher than that of ru-fURS (OR=2.61, 95%CI: 1.34-5.07, P=0.005).Conclusion The efficacy and safety of su-fURS and ru-fURS in the treatment of upper urinary tract stones are comparable, but su-fURS has a higher efficacy rate for lower renal calyceal calculi.Further high-quality studies are needed to validate this conclusion. -
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表 1 纳入文献基本特征
作者 年份 研究类型 样本数/例 年龄/岁 随访时间 结局指标 试验组 对照组 试验组 对照组 甘云辉等[9] 2022 RCT 38 42 45.6±9.0 45.9±9.3 1 d ①②④ Ali等[10] 2022 回顾性分析 121 121 48.2±13.0 47.6±12.4 1个月 ①⑤ Huang等[11] 2021 回顾性分析 119 119 49.4±12.7 49.0±12.0 1个月 ①④⑥ Eismann等[12] 2022 回顾性分析 35 23 - - - ①③⑤ 廖文彪等[13] 2022 RCT 90 88 48.40±11.36 47.40±12.53 3 d ①⑥ 谭剑敏等[14] 2022 回顾性分析 30 34 45.2±6.6 48.0±5.6 1 d ①④⑤⑥ Yang等[15] 2021 RCT 25 24 52.72±11.79 54.00±12.69 1个月 ①②③④⑤⑥ Mourmouris等[16] 2021 回顾性分析 40 37 55.73±13.47 55.0±11.2 1 d ①③④⑤⑥ Göger等[17] 2021 回顾性分析 52 70 52.4±19.4 48.73±14.7 1个月 ①②④⑤⑥ 王辉等[18] 2021 RCT 30 30 41.56±8.47 42.06±8.26 7 d ①②⑥ Qi等[19] 2020 RCT 63 63 51.84±13.16 53.25±12.11 1个月 ①③④⑤⑥ 朱玮等[20] 2020 RCT 45 45 45.1±9.3 44.5±8.5 1 d ①⑥ Salvadó等[21] 2019 回顾性分析 31 30 50.4±13.8 49.9±16.5 1个月 ①②⑤ Mager等[22] 2018 回顾性分析 68 68 54±17 59±16 - ①⑥ Usawachintachit等[23] 2017 回顾性分析 115 65 55.8±15.1 50.5±12.6 3个月 ①③④⑤⑥ Ding等[24] 2015 RCT 180 180 50.5±12.8 51.1±13.7 1 d ①④⑤⑥ 注：“-”为未描述。①总有效率；②肾下盏碎石有效率；③套石篮使用率；④术后住院时间；⑤术前双J管留置率；⑥ClavienⅠ~Ⅱ并发症发生率。 
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表 2 纳入文献NOS评分结果(非RCT)
第一作者/年份 研究对象选择 组间可比性 暴露因素测量 评价 1 2 3 4 5 6 7 8 9 Usawachintachit 2017 * * * * * - * * - 7 Mager 2018 * * * * * - * * - 7 Salvadó 2019 * * * * * - * * - 7 Göger 2021 * * * * * - * * - 7 Mourmouris 2021 * * * * * - * * - 7 Huang 2021 * * * * * - * * - 7 Eismann 2022 * * * * * - * * - 7 Ali 2022 * * * * * - * * - 7 谭剑敏2022 * * * * * - * - - 6 注：1为病例确定是否恰当；2为病例的代表性；3为对照的选择；4为对照的确定；5为控制最重要的混杂因素；6为控制任何其他的混杂因素；7为暴露因素的确定；8为采用相同方法确定病例和对照组暴露因素；9为无应答率；“*”为已描述；“-”为未描述。
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