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

doi:10.3877/cma.j.issn.1674-3253.2017.01.007

Abstract

Abstract:

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.

Key words: Kidney stone, Percutaneous nephrolithotripsy (PCNL), Tube, Meta

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]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(01): 26-31.

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Figures/Tables 7

References 21

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作者年份	年份	研究时间	国家	造瘘管有无	例数	平均年龄（岁）	造瘘管型号（F）	碎石器械	体质量指数（kg/m²）	结石大小
Mukta等^[1]	2016	2014/8~2016/1	印度	有	35	-	-	-	-	2.03 cm
Mukta等^[1]	2016	2014/8~2016/1	印度	无	31	-	-	-	-	2.12 cm
Yong等^[20]	2003	2009/8~2010/7	中国	有	16	46.25±22.37	16	钬激光	-	（3.29±0.54）cm
Yong等^[20]	2003	2009/8~2010/7	中国	无	16	43.81±18.89	-	-	-	（3.11±0.62）cm
Chang等^[7]	2011	2005/2~2008/1	中国台湾	有	63	58.70±10.85	20	气压弹道	25.06±2.64	（2.49±0.28）cm
Chang等^[7]	2011	2005/2~2008/1	中国台湾	无	68	59.22±12.44	-	-	25.04±2.51	（2.47±0.27）cm
Pedro等^[4]	2011	2006/11~2007/12	智利	有	45	47.2	18	气压弹道	27.8	7.8 cm²
Pedro等^[4]	2011	2006/11~2007/12	智利	无	40	52.8	-	-	28.7	6.4 cm
Mishra等^[9]	2010	-	印度	有	11	42.5	20	-	24.3	-
Mishra等^[9]	2010	-	印度	无	11	42.3	-	-	25.1	-
Okan等^[11]	2009	2005/6~2007/7	土耳其	有	45	43.91±14.44	14	气压弹道	-	-
Okan等^[11]	2009	2005/6~2007/7	土耳其	无	45	47.48±13.04	-	-	-	-
Crook等^[3]	2008	-	英国	有	25	53	26	气压弹道+液电	-	1.75 cm
Crook等^[3]	2008	-	英国	无	25	52	-	-	-	2.16 cm
Fatih等^[13]	2007	2003/1~2004/1	土耳其	有	18	41.3±14.7	14	气压弹道	-	-
Fatih等^[13]	2007	2003/1~2004/1	土耳其	无	17	38.4±12.3	-	-	-	-
Desai等^[14]	2004	2001/1~2001/6	印度	有	20	42.2	20	-	-	249.1 mm²
Desai等^[14]	2004	2001/1~2001/6	印度	无	10	41.1	-	-	-	253.3 mm²
Feng等^[21]	2001	1999/3~1999/8	美国	有	10	-	22	-	-	（8.368±2.66）cm³
Feng等^[21]	2001	1999/3~1999/8	美国	无	8	-	-	-	-	（4.388±0.95）cm³

作者年份	年份	研究时间	国家	造瘘管有无	例数	平均年龄（岁）	造瘘管型号（F）	碎石器械	体质量指数（kg/m²）	结石大小
Mukta等^[1]	2016	2014/8~2016/1	印度	有	35	-	-	-	-	2.03 cm
Mukta等^[1]	2016	2014/8~2016/1	印度	无	31	-	-	-	-	2.12 cm
Yong等^[20]	2003	2009/8~2010/7	中国	有	16	46.25±22.37	16	钬激光	-	（3.29±0.54）cm
Yong等^[20]	2003	2009/8~2010/7	中国	无	16	43.81±18.89	-	-	-	（3.11±0.62）cm
Chang等^[7]	2011	2005/2~2008/1	中国台湾	有	63	58.70±10.85	20	气压弹道	25.06±2.64	（2.49±0.28）cm
Chang等^[7]	2011	2005/2~2008/1	中国台湾	无	68	59.22±12.44	-	-	25.04±2.51	（2.47±0.27）cm
Pedro等^[4]	2011	2006/11~2007/12	智利	有	45	47.2	18	气压弹道	27.8	7.8 cm²
Pedro等^[4]	2011	2006/11~2007/12	智利	无	40	52.8	-	-	28.7	6.4 cm
Mishra等^[9]	2010	-	印度	有	11	42.5	20	-	24.3	-
Mishra等^[9]	2010	-	印度	无	11	42.3	-	-	25.1	-
Okan等^[11]	2009	2005/6~2007/7	土耳其	有	45	43.91±14.44	14	气压弹道	-	-
Okan等^[11]	2009	2005/6~2007/7	土耳其	无	45	47.48±13.04	-	-	-	-
Crook等^[3]	2008	-	英国	有	25	53	26	气压弹道+液电	-	1.75 cm
Crook等^[3]	2008	-	英国	无	25	52	-	-	-	2.16 cm
Fatih等^[13]	2007	2003/1~2004/1	土耳其	有	18	41.3±14.7	14	气压弹道	-	-
Fatih等^[13]	2007	2003/1~2004/1	土耳其	无	17	38.4±12.3	-	-	-	-
Desai等^[14]	2004	2001/1~2001/6	印度	有	20	42.2	20	-	-	249.1 mm²
Desai等^[14]	2004	2001/1~2001/6	印度	无	10	41.1	-	-	-	253.3 mm²
Feng等^[21]	2001	1999/3~1999/8	美国	有	10	-	22	-	-	（8.368±2.66）cm³
Feng等^[21]	2001	1999/3~1999/8	美国	无	8	-	-	-	-	（4.388±0.95）cm³

项目	研究文献数（条）	纳入患者数目（例）	P值	RR or MD (95%CI)	异质性P值	I²
手术时间	6	336	0.02	4.46 [0.65,8.27]	0.006	53%
住院时间	5	204	<0.001	1.15 [0.93, 1.36]	0.25	25%
血红蛋白下降量（g/L）	6	336	0.23	-0.20 [-0.52, 0.12]	0.0005	78%
术后发热	6	210	0.44	1.56 [0.50, 4.81]	0.46	0%
术后输血	4	228	0.88	0.92 [0.31, 2.76]	0.48	0%
结石清除率	7	354	0.75	1.01 [0.93, 1.10]	0.41	2%
术后第三日疼痛指数（VAS）	4	300	0.002	1.65 [0.59, 2.70]	<0.001	93%
尿漏	7	422	0.47	1.98 [0.32, 12.43]	0.08	55%
恢复正常工作时间	2	197	0.045	1.34 [0.02, 2.67]	<0.001	97%

项目	研究文献数（条）	纳入患者数目（例）	P值	RR or MD (95%CI)	异质性P值	I²
手术时间	6	336	0.02	4.46 [0.65,8.27]	0.006	53%
住院时间	5	204	<0.001	1.15 [0.93, 1.36]	0.25	25%
血红蛋白下降量（g/L）	6	336	0.23	-0.20 [-0.52, 0.12]	0.0005	78%
术后发热	6	210	0.44	1.56 [0.50, 4.81]	0.46	0%
术后输血	4	228	0.88	0.92 [0.31, 2.76]	0.48	0%
结石清除率	7	354	0.75	1.01 [0.93, 1.10]	0.41	2%
术后第三日疼痛指数（VAS）	4	300	0.002	1.65 [0.59, 2.70]	<0.001	93%
尿漏	7	422	0.47	1.98 [0.32, 12.43]	0.08	55%
恢复正常工作时间	2	197	0.045	1.34 [0.02, 2.67]	<0.001	97%

组别	研究数型	文献数量	样本数量	研究年份	手术时间	住院时间	血红蛋白下降量（g/L）
Claudio等^[8]	随机对照+临床对照试验	10	621	2010	MD1.55[-2.76, 5.86]	MD-1.35[-1.40，-1.29]	MD-0.02[-0.07，0.02]
Zhong等^[12]	随机对照+临床对照试验	9	652	2013	WMD-1.44[-8.27，-0.01]	WMD-1.09[-1.33，-0.85]	WMD-0.07[-0.21，0.06]
本研究	随机对照	10	559	2016	MD4.46[0.65，8.27]	MD4.46[0.65，8.27]	MD-0.20[-0.52，0.12]
组别	术后发热	术后输血	结石清除率	术后第三日疼痛指数（VAS）	尿漏	恢复正常工作时间
Claudio等^[8]	OR7.28[2.20，24.06]	NA	OR1.17[0.56，2.44]	NA	OR0.13[0.04，0.38]	NA
Zhong等^[12]	RR0.53[0.16，1.69]	RR0.84[0.37，1.91]	NA	NA	NA	NA
本研究	RR1.56[0.50，4.81]	RR0.92[0.31，2.76]	RR1.01[0.93，1.10]	MD1.65[0.59，2.70]	RR1.98[0.32，12.43]	MD1.3[0.02，2.67]

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