微创泌尿外科杂志

目的：比较一次性输尿管软镜联合可弯曲负压吸引鞘钬激光碎石术与经皮肾镜碎石取石术(PCNL)治疗上尿路结石（2～3 cm）的疗效与安全性。方法：检索2010年1月至2025年2月国内外有关一次性输尿管软镜联合可弯曲负压吸引鞘钬激光碎石术（联合组）与PCNL(PCNL组)治疗上尿路结石的临床研究，按Cochrane系统评价方法提取资料，采用RevMan5.6统计软件对两组手术时间、结石清除率、总并发症、术后发热、术后血红蛋白下降幅度、出血量及住院时间等指标进行Meta分析。结果：Meta分析最终纳入7篇中文研究，共计994例患者（联合组538例，PCNL组456例）。两组手术时间（MD=6.43,95%CI:-6.56～19.42,P=0.33）和结石清除率（OR=1.24,95%CI:0.50～3.05,P=0.65）比较差异无统计学意义；与PCNL组相比，联合组总并发症发生率更低（MD=0.33,95%CI:0.23～0.48,P<0.001）、术后发热发生率更低（OR=0.54,95%CI:0.30～1.00,P=0.05）、术后血红蛋白下降幅度更小（MD=-4.28,95%CI:-6.83～-1.73,P=0.001）、出血量更少（MD=-9.98,95%CI:-10.78～-9.19,P<0.001）及住院时间更短（MD=-2.25,95%CI:-3.21～-1.30,P<0.001）。结论：两组手术方式在手术时间和结石清除方面效果相似。与PCNL相比，可弯曲负压吸引鞘联合输尿管软镜钬激光碎石术在术后发热、住院时间、出血量、总并发症发生率及血红蛋白下降幅度等方面具有明显优势。

Methods: Clinical studies on single-use flexible ureteroscopic holmium laser lithotripsy combined with flexible negative pressure aspiration sheath(combined group) versus PCNL(PCNL group) for upper urinary tract calculi, published from January 2010 to February 2025 at home and abroad, were retrieved. Data were extracted according to the Cochrane systematic review method, and Meta-analysis was performed using RevMan 5.6 statistical software to compare indicators such as operation time, stone clearance rate, total complications, postoperative fever, postoperative hemoglobin decline, blood loss, and hospital stay between the two groups. Results: A total of 7 Chinese studies involving 994 patients(538 in the combined group and 456 in the PCNL group) were finally included in the Meta-analysis. There were no statistically significant differences in operation time(MD=6.43,95%CI:-6.56 to 19.42,P=0.33) or stone clearance rate(OR=1.24,95%CI:0.50 to 3.05,P=0.65) between the two groups. Compared with the PCNL group, the combined group had a lower incidence of total complications(MD=0.33,95%CI:0.23 to 0.48,P<0.001), a lower incidence of postoperative fever(OR=0.54,95%CI:0.30 to 1.00,P=0.05), a smaller postoperative hemoglobin decline(MD=-4.28,95%CI:-6.83 to-1.73,P=0.001), less blood loss(MD=-9.98,95%CI:-10.78 to-9.19,P<0.001), and a shorter hospital stay(MD=-2.25,95%CI:-3.21 to-1.30,P<0.001). Objective: To compare the efficacy and safety of single-use flexible ureteroscope combined with flexible negative pressure aspiration sheath in holmium laser lithotripsy versus percutaneous nephrolithotomy(PCNL) for upper urinary tract calculi(2–3 cm). Conclusion: The two surgical methods have similar effects in terms of operation time and stone clearance. Compared with PCNL, flexible negative pressure aspiration sheath combined with flexible ureteroscopic holmium laser lithotripsy has obvious advantages in postoperative fever, hospital stay, blood loss, total complication rate, and hemoglobin decline.