切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (01) : 26 -31. doi: 10.3877/cma.j.issn.1674-3253.2017.01.007

所属专题: 文献

临床研究

经皮肾镜术后造瘘管留置必要性的Meta分析及试验序贯分析
刘亚东1, 王俊1, 田河1, 刘健男1, 冯越1, 徐敏玲1, 安瑞华1,()   
  1. 1. 150001 哈尔滨医科大学附属第一医院泌尿外科一病房
  • 收稿日期:2016-07-26 出版日期:2017-02-01
  • 通信作者: 安瑞华
  • 基金资助:
    国家自然科学基金(2013)项目(81370803)

The necessity of nephrostomy tube after percutaneous nephrolithotripsy: a meta-analysis and the trial sequential analysis

Yadong Liu1, jun Wang1, he Tian1, Jiannan Liu1, Yue Feng1, Minling Xu1, Ruihua An1,()   

  1. 1. Department of Urology, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2016-07-26 Published:2017-02-01
  • Corresponding author: Ruihua An
  • About author:
    Corresponding author: An Rui-hua, Email:
引用本文:

刘亚东, 王俊, 田河, 刘健男, 冯越, 徐敏玲, 安瑞华. 经皮肾镜术后造瘘管留置必要性的Meta分析及试验序贯分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(01): 26-31.

Yadong Liu, jun Wang, he Tian, Jiannan Liu, Yue Feng, Minling Xu, Ruihua An. The necessity of nephrostomy tube after percutaneous nephrolithotripsy: a meta-analysis and the trial sequential analysis[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(01): 26-31.

目的

通过Meta分析和试验序贯分析评价经皮肾镜碎石术后造瘘管留置的必要性。

方法

计算机检索Pubmed,Embase,Cochrane Library,中国知网,万方数据库并提取数据,按照纳入和排除标准收集并筛选经皮肾镜术后造瘘管留置与否的随机对照研究,检索时限从建库至2016年7月。

结果

符合纳入标准研究10篇,共559例患者,其中术后留置造瘘管者288例,术后未留置造瘘管者271例。meta分析结果显示,未留置造瘘管组在手术时间(MD:4.46;95%CI:0.65,8.27;P=0.02)、住院时间(MD: 1.15;95%CI: 0.93,1.36;P<0.01)、术后第三天疼痛指数(MD:1.65;95% CI:0.59,2.70;P=0.002)、恢复正常工作时间(MD:1.34;95% CI:0.02,2.67;P=0.045)方面明显低于术后留置造瘘管研究组。

结论

对于非复杂性经皮肾镜碎石取石术的患者而言,未留置造瘘管并不会增加术后发热、出血增加等不适反应。但试验序贯分析提示手术时间、术后发热、血红蛋白下降方面仍需进一步研究论证二者间差异。

Objective

The evaluate whether the placement of the tube should be advised after the percutaneous nephrolithotripsy by Meta-analysis and trial sequential analysis (TSA).

Methods

Computer retrieval of PubMed, Embase, Cochrane, CNKI and Wanfang, according to the inclusion and exclusion criteria were collected and screened out a randomized controlled studies on whether nephrostomy tube placement after the percutaneous nephrolithotripsy, published from inception to July 2016.

Results

Ten studies met the inclusion criteria with a total of 559 patients, including 288 cases of nephrostomy tube placement group and 271 cases of the tubeless group. The operation time (MD: 4.46; 95% CI: 0.65, 8.27; P=0.02), hospital stays (MD: 1.15; 95%CI: 0.93, 1.36 P<0.01), pain accessment (MD: 1.65; 95%CI: 0.59, 2.70; P=0.002), time to returning to work (MD: 1.34; 95% CI: 0.02, 2.67; P=0.045) of tubeless group were significantly lower than the tube group.

Conclusions

The tubeless group will not increase the incidence of fever and bleeding for the patient with out complex percutaneous nephrolithotripsy. But the trial sequential analysis does not allow us to draw the solid conclusion in operation time, fever and hemoglobin drop.

图1 流程图
表1 meta纳入对象研究特征
图2 TSA:2a为结石清除率;2b为手术时间;2c为术后发热;2d为术后疼痛指数
图2 TSA:2e为血红蛋白下降量;2f为住院时间
表2 经皮肾镜术后造瘘管有无留置的各项研究指标比较汇总
图3 风险偏倚
表3 不同作者间PCNL术后造瘘管有无的meta分析之间的比较
[1]
Vig M, Vig V, Nagi G, et al. Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy[J]. Int J Res Med Sci, 2016, 4(5): 1379-1382.
[2]
Malcolm B, Derweesh H, Brightbill Keith, et al. Tubeless percutaneous nephrolithotomy for complex renal stone disease: single center experience[J]. Can J Urol, 2008, 15(3): 4072-4076.
[3]
Crook TJ, Lockyer CR, Keoghane SR, et al. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy[J]. J Urol, 2008, 180(2): 612-614.
[4]
Marchant F, Recabal P, Fernández MI, et al. Postoperative morbidity of tubeless versus conventional percutaneous nephrolithotomy: a prospective comparative study[J]. Urolithiasis, 2011, 39(6): 477-481.
[5]
Stewart A, Clarke Mike, Rovers Maroeska, et al. Preferred reporting items for systematic review and Meta-Analyses of individual participant data: the PRISMA-IPD statement[J]. JAMA, 2015, 313(16): 1657-1665.
[6]
IVD Tweel, C Bollen. Sequential meta-analysis: an efficient decision-making tool[J]. Clinical Trials, 2010, 7(2): 136-146.
[7]
Chang CH, Wang CJ, Huang SW. Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study[J]. Urol Res, 2011, 39(6): 459-465.
[8]
Borges CF, Fregonesi A, Silva DC. Systematic review and Meta-Analysis of nephrostomy placement versus tubeless percutaneous nephrolithotomy[J]. J Endourol, 2010, 24(11): 1739-1746.
[9]
Mishra S, Sabnis RB, Kurien A, et al. Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL[J]. BJU Int, 2010: 106(7): 1045-1048.
[10]
Sebaey Ahmed, Khalil M, Soliman Tarek, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial[J]. Arab J Urol, 2016, 14(1): 18-23.
[11]
Istanbulluoglu Okan, Ozturk Bulent, Gonen Murat, et al. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study[J]. Int Urol Nephrol, 2009, 41(3): 541-545.
[12]
Zhong Q, Zheng C, Mo J, et al. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis[J]. J Endourol, 2013, 27(4): 420-426.
[13]
Tefekli Ahmet, Altunrende Fatih, Tepeler Kadir, et al. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison[J]. Int Urol Nephrol, 2007, 39(1): 57-63.
[14]
Desai R, Kukreja A, Desai M, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless[J]. J Urol, 2004, 172(2): 565-567.
[15]
Kara C, Resorlu B, Bayindir M, et al. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients[J]. Urology, 2010, 76(2): 289-293.
[16]
Wang KJ, Huang WS, Yang M, et al. Tubeless versus standard percutaneous nephrolithotomy for treating kidney stones. Cochrane Database of Systematic Reviews[J]. Mol Immunol, 2007, 44(8): 1961-1968.
[17]
Wang J, Zhang C, Tan G, et al. The use of adjunctive hemostatic agents in tubeless percutaneous nephrolithotomy: a meta-analysis (Provisional abstract)[J]. Urolithiasis, 2014, 42(6): 509-517.
[18]
Taghavi R, Darabi MR, Jahde SA. Comparison of the results and complications between standard and tubeless percoutaneous nephrolithotomy[J]. Eur urol suppl, 2013, 12(4): 175-187.
[19]
Sebaey A, Khalil M M, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial[J]. Arab J Urol, 2016, 14(1): 18-23.
[20]
Lu Y, Ping JG, Zhao XJ, et al. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy[J]. World J Urol, 2013, 31(5): 1303-1307.
[21]
Feng MI, Tamaddon K, Mikhail A, et al. Prospective randomized study of various techniques of percutaneous nephrolithotomy[J]. Urology, 2001, 58(3): 345-350.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3] 吴义刚, 潘裕民, 吴姗姗, 胡梦涓, 王一为, 张劲松, 乔莉. 左西孟旦治疗肺动脉高压合并右心衰竭患者疗效分析——Meta 分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 385-391.
[4] 张秋阳, 余韶芸, 潘向滢, 金家佳, 夏桦, 赵雪红. 成年体外膜肺氧合患者出血影响因素的Meta 分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 392-398.
[5] 曹彬, 王强, 卢扬柏, 黄红星, 黄亚强, 龙永富, 钟睿, 李灿永, 罗刚. 单孔经皮肾镜和腹腔镜处理肾囊肿的术式对比研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 566-571.
[6] 石兵, 张智, 陈金海, 唐文. 基于电磁跟踪和手术导航系统的实时超声引导下两种经皮肾盏穿刺方法的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 572-578.
[7] 王铭池, 梁乐琦, 刘永达. 基于NHANES数据库分析血脂与肾结石之间的关系[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 485-490.
[8] 方道成, 唐春华, 胡媛媛. 肠道菌群对草酸钙肾结石形成的影响[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 509-513.
[9] 苏博兴, 肖博, 李建兴. 2024年美国泌尿外科学会年会结石领域手术治疗相关热点研究及解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 303-308.
[10] 张斌, 孙代宇, 胡昕, 韩菲, 李久明, 李功雨, 吴伟力, 冯宝富, 彭国辉. 评分系统预测不同经验手术者输尿管软镜术后结石清除率准确性的比较研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 353-360.
[11] 莫淇舟, 柳建军, 叶木石, 黄兴端, 李健维, 李思宁, 黄健, 苏劲. 二期原通道经皮肾镜联合输尿管软镜治疗经皮肾镜术后残石[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 380-385.
[12] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[13] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[14] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要