经皮肾镜碎石取石术联合负压吸引治疗肾结石的Meta分析

目的比较经皮肾镜碎石取石术（PCNL）联合负压吸引与无负压的PCNL在治疗肾结石的安全性和有效性。 方法检索英文数据库PubMed、EMBASE、the Cochrane Controlled Trial Register of Controlled Trials；中文数据库中国知网（CNKI）、万方、中国生物医学数据库（建刊至今）。收集两种术式治疗肾结石的随机对照研究，2位研究者独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.3软件进行Meta分析。 结果共纳入12篇随机对照研究（RCT），样本量为1 100例肾结石患者（负压组538例，无负压组562例）。Meta分析表明，两组在感染性休克[RR=0.43，95%CI（0.12，1.63），P=0.22]、ClavienⅠ级并发症[RR=0.83，95%CI（0.47，1.48），P=0.53]及ClavienⅢ级以上并发症[RR=1.12，95%CI（0.40，3.15），P=0.83]方面差异无统计学意义，但PCNL联合负压吸引组结石清除率更高[RR=1.11，95%CI（1.00，1.23），P=0.05]，在手术时间[MD=-10.03，95%CI（-15.79，-4.27），P=0.0006]、术后发热[RR=0.41，95%CI（0.27，0.61），P<0.001]、出血量[MD=-71.63，95%CI（-136.89，-6.37），P=0.03]、Clavien总体并发症[RR= 0.54，95%CI（0.41，0.71），P<0.001]、ClavienⅡ级并发症[RR=0.43，95%CI（0.30，0.60），P<0.001]及肾盂内压方面[MD=-10.47%，95%CI（-11.49，-9.45），P<0.001]也优于无负压组。 结论与无负压组相比，PCNL联合负压吸引能够提高结石清除率，缩短手术时间，降低肾盂内压，减少术后发热、出血等并发症。同时并未增加感染性休克、ClavienⅠ级及Ⅲ级以上并发症的发生率。

Percutaneous nephrolithotomy with concurrent negative pressure aspiration for renal calculus: a systematic review and meta-analysis

ObjectiveTo compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) with or without concurrent aspiration in the treatment of renal calculus. MethodsWe systematically searched PubMed, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials, CNKI, Wanfang, and Chinese Biological Medical Database for randomized controlled trials comparing PCNL with or without aspiration in adult patients with renal calculus. Study quality was assessed by the criteria outlined in the Cochrane Handbook for Systematic Reviews of intervention. Meta-analysis was performed by Reviewer Manager Software, Version 5.3. ResultsTwelve trials with 1 100 patients met the inclusion criteria and were entered into the final analysis. Our pooled analysis showed that PCNL with concurrent aspiration could reduce surgical duration [MD=-10.03; 95%CI(-15.79, -4.27), P=0.0006], postoperative fever [RR=0.41, 95%CI(0.27, 0.61), P<0.001], hemorrhage [MD=-71.63, 95%CI(-136.89, -6.37), P=0.03], Total clavien complication rate [RR=0.54; 95%CI(0.41, 0.71); P<0.001], Clavien Grade II complication rate [RR=0.43, 95%CI(0.30, 0.60), P<0.001], and renal pelvic pressure [MD=-10.47, 95%CI(-11. 49, -9.45), P<0.001]. It could also enhance the stone-free rate [RR=1.11, 95%CI(1.00, 1.23), P=0.05]. However, there was no difference with respect to septic shock [RR=0.43, 95%CI(0.12, 1.63), P=0.22], Clavien Grade I complications [RR=0.83, 95%CI(0.47, 1.48), P=0.53] and Clavien Grade III and above complications [RR=1.12, 95%CI (0.40, 3.15), P=0.83]. ConclusionsCompared to PCNL without suction, this meta-analysis shows that PCNL with concurrent aspiration results in a significantly higher stone-free rate and a decrease in surgical duration, fever occurrence, hemorrhage, Clavien total complications, Clavien Grade II complications, and renal pelvic pressure, without an increase in the incidence of septic shock, Clavien Grade I, III and above complications.