A Meta-analysis Of Minimally Invasive S Urgical Treatment For Renal Or Ureteral Calculi

BackgroundUrinary lithiasis is a very common disease in urology with a high incidence rate. As the development of meditech, minimally invasive surgical treatments be come the major treatment for urinary lithiasis. Extracorporeal shockwave lithotri psy and percutaneous nephrolithotomy (include minimally invasive percutaneous n ephrolithotomy) and retrograde ureteroscopic lithotripsy (include retrograde flexibl e ureteroscopic lithotripsy) and retroperitoneal laparoscopic ureterolithomy are the most popular operation for urinary calculus. Now, extracorporeal shockwave lith otripsy has a very clear qualification to treat renal stone. But there is still have dissidence on which one should be the first treatment recommended to patients with renal stone between1-3mm about percutaneous nephrolithotomy and retrogra de ureteroscopic lithotripsy. Otherwise, on the treatment of simple ureteral calculi extracorporeal shockwave lithotripsy is the first line treatment. But complicated upper ureteral calculi is not the indication for extracorporeal shockwave lithotrips y. So, percutaneous nephrolithotomy and retrograde ureteroscopic lithotripsy and r etroperitoneal laparoscopic ureterolithomy are used for complicated upper ureteral calculi. But different results were given by a lot of researches.Our study resolves the dissidence by evidence-based medicine method and c ollect clinical information of patients be treated by the operations and supply a s trong evidence for clinical doctors.Part1:Objective:Collect clinical information of patients be treated by the operatio ns and use the Corhrane method of system review to evaluate the treatment effe ct and security of percutaneous nephrolithotomy and retrograde flexible ureterosco pic lithotripsy for renal calculi of1-3cm.Method:Analysis the clinical information and collect all articles about the t wo treatments from CNKI/VIP/WANFANG DATE/SCIE/PUBMED/ELESEVIER/S PRINGE/CORHRANE online. Analysis the success ratio and calculi free rate and complication incidence rate and hospital stay time of the two method by pair w ise comparison with RveMan5.1software.Result:Retrograde flexible ureteroscopic lithotripsy has lower calculi free ra te (p<0.01),but shorter hospital stays. There is no significant difference on one p rocess achievement ratio and complication ration and operation time between the two treatment (p>0.05). Further more, Retrograde flexible ureteroscopic lithotri psy get a less loss of blood.Conclusion:There is enough evidence to provide retrograde flexible ureteros copic have approximately one process achievement ratio and complication ration and operation time, but less loss of blood.Retrograde flexible ureteroscopic litho tripsy should be the first choice for patients with renal stone between1-3cm. Part2Objective:Use the Corhrane method of system review to evaluate the treat ment effect and security of three minimally invasive surgical treatments(percutane ous nephrolithotomy and retrograde ureteroscopic lithotripsy and retroperitoneal laparoscopic ureterolithomy) for complicated upper ureteral calculi.Method:collect all articles of the three treatments from CNKI/VIP/WANFA NG DATE/SCIE/PUBMED/ELESEVIER/SPRINGE/CORHRANE online. Analysis t he success ratio and calculi free rate and complication incidence rate of each op eration by pair wise comparison with RveMan5.1software.Result:Ureteroscopic lithotripsy (URL) has shorter hospital stays (p<0.01), but lower success ratio (p<0.01) and calculi free rate (p<0.01). Otherwise, Retrop eritoneal laparoscopic ureterolithomy (RLU) is advanced than percutaneous nephro lithotomy (PCNL) on calculi free rate (p<0.01) and complication incidence rate (p<0.05)Conclusion:URL should be the fist choice for complicate upper ureteral cal culi and RLU could be the second choice. PCNL is not suitable for patients wh o with upper ureteral calculi.