完全无管化与标准经皮肾镜治疗肾结石的Meta分析

目的系统评价完全无管化经皮肾镜碎石取石术(PCNL)与标准PCNL治疗肾结石的有效性和安全性。方法检索PubMed、Embase、Cochrane Library数据库。检索时限为从建库到2018年2月28日关于完全无管化PCNL和标准PCNL治疗肾结石的随机对照试验或回顾性病例对照试验,2名作者独立进行文献筛查和数据提取,运用RevMan 5.3软件进行Meta分析。结果共纳入5篇随机对照研究,2篇病例对照研究,共计781例患者,其中完全无管化PCNL组379例,标准PCNL组402例。Meta分析结果显示:完全无管化PCNL组的手术时间短于标准PCNL组(WMD:-2.72;95%CI:-4.05^-1.39;P<0.001);住院时间短于标准PCNL组(WMD:-1.48;95%CI:-1.84^-1.11;P<0.001);术后镇痛需求低于标准PCNL组(WMD:-6.91;95%CI:-9.00^-4.82;P<0.001);两组在结石清除率、术后血红蛋白丢失量及输血率方面差异均无统计学意义。结论完全无管化PCNL在治疗选择性肾结石患者方面优于标准PCNL,可以明显减少手术时间、住院时间和术后镇痛需求,而且不会增加手术相关的并发症。医师应根据患者的实际情况,个体化选择治疗方案。

Totally tubeless percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for kidney stones: a Meta-analysis

ObjectiveTo systematically review the efficacy and safety of totally tubeless percutaneous nephrolithotomy (PCNL) and standard PCNL in management of kidney stones. MethodsPubMed, Embase and Cochrane Library were searched from the beginning of database to February 28, 2018. Randomised controlled trials (RCT) and retrospective case-control study (CCS) that compared the two above operation for treatment of kidney stones were collected. Two researchers independently filtered literature and extracted data. The meta-analysis was performed using the RevMan 5.3 software. ResultsFive RCT and two CCS including 781 patients, which consists of 379 cases totally tubeless PCNL and 402 cases standard PCNL. The results of meta-analysis showed that compared with standard PCNL, the totally tubeless PCNL showed shorter operation time (WMD: -2.72; 95%CI: -4.05 to -1.39; P<0.001), shorter hospital stay (WMD: -1.48; 95%CI: -1.84 to -1.11; P<0.001), lower analgesic requirement (WMD: -6.91; 95%CI: -9.00 to -4.82; P<0.001). There was no significant difference in stone-free rate, hemoglobin decrease and blood transfusion between the two groups. ConclusionsTotally tubeless PCNL is better than standard PCNL in the management of selected kidney stone patients, with significantly shorter operative time, shorter hospital stay, lower analgesic requirement, and don't increase relevant operation morbidity. Selection of the treatment plan should base on the actual situation of the patients personally.