国内斜卧位与俯卧位经皮肾镜取石术的Meta分析

目的 系统评价国内成人斜卧位与俯卧位经皮肾镜取石术两种手术方式的安全性和有效性.方法 系统检索中国生物医学文献数据库(CBM)、中国知网(CNKI)和维普中文科技期刊数据库(VIP)、万方中国学术期刊数据库(CSPD),并辅以手工检索,检索时间均为建库至2015年10月,查找所有研究,比较国内斜卧位与俯卧位经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗上尿路结石的对照试验,按纳入排除标准由两人独立进行筛选、资料提取和质量评价,采用Revman 5.3软件进行Meta分析.结果 共纳入6项研究.Meta分析结果显示:与俯卧位PCNL相比,斜卧位PCNL减少了出血量和术后并发症发生率,而手术时间、结石清除率方面无显著性差异.结论 斜卧位经皮肾镜是安全有效的上尿路结石治疗手段.斜卧位与俯卧位经皮肾镜取石术两种术式相比,在出血量、术后并发症发生率等方面存在优势,而在手术时间、结石清除率等方面并无明显差异.但由于该Meta分析纳入研究仅在国内,数量少,有存在选择偏倚、实施偏倚与发表偏倚的可能性,需要更多高质量、大样本的随机对照试验提供更可靠的循证医学证据.

Recumbent position versus prone position in percutaneous nephrolithotomy in China: a Meta analysis

Objectives To systematically review the clinical therapeutic efficacy and safety of recumbent position versus prone position in percutaneous nephrolithotomy (PCNL) in China.Methods CBM,CNKI,VIP and CSPD without language restriction from their establishment to October 2015 were searched to collect the controlled trials about recumbent position versus prone position PCNL in the treatment of upper urinary tract stones in China,and the references of those controlled trials were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,were analyzed by Cochrane Collaboration's RevMan 5.3 software.Results Six studies were included.Compared with the prone position PCNL,recumbent position PCNL had shorter operation blood loss,complication incidence rate,but no significant difference was found with regard to operative time,stone clearance rate.Conclusions Recumbent position PCNL is a safe and effective method for upper ureteral calculi.Compared with prone position PCNL,recumbent position PCNL can reduce operation blood loss,complication incidence rate,without increasing other complications.Because of the small number of the included studies,which weakens the strength of the evidence of our results,there is a moderate possibility of selection bias,performance bias and publication bias in this Meta-analysis.More high-quality and large-sample studies are needed to provide further evidences in evidence-based medicine.