无管化与标准化经皮肾镜取石术比较的荟萃分析

A meta-analysis of tubeless versus standard percutaneous nephrostolithotomy

目的系统评价无管化经皮肾镜取石术的优势。方法搜集国外有关无管化经皮肾镜取石术与标准经皮肾镜取石术的随机对照试验文献，并追查已纳入文献的参考文献。对符合纳入标准的研究使用统计软件RevMan5．0完成荟萃分析。结果经筛选，最后纳入7篇文献，均为随机对照试验，受试患者共包括1365例。与标准经皮肾镜取石术比较，无管化经皮肾镜取石术患者：（1）平均手术时间及血红蛋白改变差异无统计学意义（95％CI：-15．16～0．13，-0．16～0．19；P=0．050，0．900）；（2）住院时间平均缩短了23．86h（95％CI：-32．35～-15．36，P=0．000）；（3）术后镇痛药的使用剂量减少了69．02mg（95％CI：-107．67～-30．36，P=0．000）；（4）结石清除率显著提高（95％CI：1．25～2．95，P=0．003）。结论无管化经皮肾镜取石术对于选择性患者在缩短住院时间、结石清除率及减少镇痛药的使用剂量方面较标准经皮肾镜取石术更具优势。

Objective To systematically review the advantages of tubeless percutaneous nephrolithotomy. Methods The randomized controlled trials （RCTs） of tubeless and standard percutaneous nephrolithotomy were retrieved and their included references investigated. Data analyses of literatures fulfilling the inclusion criteria were performed with the Cochrane ColLaboration＇s RevMan 5.0 software. Results Seven literatures were finally retrieved after screening. A total of 1365 patients were included for a meta-analysis. The results showed that, as compared with the control group （standard percutaneous nephrolithotomy）, the patients in the trial group （tubeless percutaneous nephrolithotomy） had the following features. （ 1 ） There was no significant difference in mean operative duration and change of hemoglobin（95% CI -15.16 to 0. 13, P = 0. 05; 95% CI -O. 16 to 0. 19, P = 0. 90 respectively）. （2） The hospitalization stay was shortened an average of 23.86 hours （95% CI - 32. 35 to - 15.36, P = 0. 000）. （3） The postoperative analgesic dose was lowered by 69. 02 mg（95% CI - 107.67 to - 30. 36, P =0. 000）. （4）There was a remarkable improvement of the stone-free rate （95% CI 1.25 to 2. 95, P = 0. 003 ）. Conclusion Tubeless pereutaneous nephrolithotomy may shorten the hospitalization stay, lower the postoperative analgesic dose and improve the stone-free rate. It is significantly superior to standard percutaneous nephrolithotomy.