Efficacy and safety of totally tubeless percutaneous nephrolithotomy for upper urinary calculus: meta-analysis
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摘要: 目的：系统评价完全无管化经皮肾镜取石术（PCNL）与标准PCNL治疗上尿路结石的安全性和疗效。方法：计算机检索Embase、The Cochrane Library、PubMed、CNKI、VIP及万方数据库，全面收集有关完全无管化PCNL和标准PCNL比较的RCT，检索时限为1984年1月~2017年11月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后，采用RevMan 5.3软件进行荟萃分析。结果：共纳入12篇研究，共885例患者。结果显示：与标准PCNL相比，完全无管化PCNL住院时间更短（MD=-1.56，95%CI：-1.95~-1.17，P<0.000 01），手术时间更短（MD=-2.36，95%CI：-3.75~-0.98，P=0.000 8），重返工作时间更短（MD=-6.77，95%CI：-11.57~-1.96，P=0.006），术后VAS疼痛评分更低（MD=-2.09，95%CI：-3.38~-0.80，P=0.002），而在结石清除率、漏尿、发热、输血、术后血红蛋白下降量、术后肌酐下降量、总并发症方面差异均无统计学意义（P>0.05）。结论：完全无管化PCNL是安全、有效的，与标准PCNL相比，可缩短住院时间、减轻患者术后疼痛不适、快速康复，在把握适应证的情况下，建议在临床推广应用。Abstract: Objective: To evaluate the safety and efficacy of totally tubeless versus standard percutaneous nephrolithotomy(PCNL). Method: Relevant randomized or quasi-randomized controlled trials studies were identifed from electronic database Embase, The Cochrane Library, PubMed, CNKI, VIP and Wanfang. The retrieval time span was from Jan. 1984 inception to Nov. 2017. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. And then the meta-analysis was conducted using RevMan 5.3 software. Result: A total of 12 studies were included, and 885 cases were involved. In comparison with standard PCNL, totally tubeless PCNL showed significantly shorter hospital stay(MD=-1.56, 95%CI:-1.95--1.17, P<0.000 01), shorter operation time(MD=-2.36, 95%CI:-3.75--0.98), P=0.000 8), shorter instauration work time(MD=-6.77, 95%CI:-11.57--1.96, P=0.006) and lower pain scores(MD=-2.09, 95%CI:-3.38--0.80, P=0.002). But no statistically significant difference was found in stone free rate, urine leakage, fever, transfusion, postoperative changes of hemoglobin or general complications(P>0.05).Conclusion: Totally tubeless PCNL is safe and effective for specific indications. Totally tubeless PCNL is preferred to standard PCNL in clinical application for its advantages of shorter hospital stay, less postoperative pain and faster recovery.
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Key words:
- calculus /
- percutaneous nephrolithotomy /
- totally tubeless /
- meta-analysis
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