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中华腔镜泌尿外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 26 -30. doi: 10.3877/cma.j.issn.1674-3253.2020.01.007

所属专题: 文献

临床研究

完全无管化与标准经皮肾镜治疗肾结石的Meta分析
钟芳灵1, 梁雄发1, 黄健1, 吴伟宙1, 胡晨波1, 吴文起1, 曾国华1, 雷鸣1,()   
  1. 1. 510230 广州医科大学附属第一医院泌尿外科
  • 收稿日期:2018-09-03 出版日期:2020-02-01
  • 通信作者: 雷鸣
  • 基金资助:
    广州医科大学高水平大学临床研究培育项目(B185004063); 国家自然科学基金(81570633)

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

Fangling Zhong1, Xiongfa Liang1, Jian Huang1, Weizhou Wu1, Chenbo Hu1, Wenqi Wu1, Guohua Zeng1, Ming Lei1,()   

  1. 1. Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
  • Received:2018-09-03 Published:2020-02-01
  • Corresponding author: Ming Lei
  • About author:
    Corresponding author: Lei Ming, Email:
引用本文:

钟芳灵, 梁雄发, 黄健, 吴伟宙, 胡晨波, 吴文起, 曾国华, 雷鸣. 完全无管化与标准经皮肾镜治疗肾结石的Meta分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(01): 26-30.

Fangling Zhong, Xiongfa Liang, Jian Huang, Weizhou Wu, Chenbo Hu, Wenqi Wu, Guohua Zeng, Ming Lei. Totally tubeless percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for kidney stones: a Meta-analysis[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(01): 26-30.

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。

Objective

To systematically review the efficacy and safety of totally tubeless percutaneous nephrolithotomy (PCNL) and standard PCNL in management of kidney stones.

Methods

PubMed, 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.

Results

Five 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.

Conclusions

Totally 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.

表1 完全无管化与标准PCNL治疗肾结石的Meta分析纳入7项研究的基本特征
图1 文献偏倚风险评估结果
图2 完全无管化PCNL与标准PCNL比较的Meta分析
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