国内无管化与标准化经皮肾镜取石术治疗上尿路结石的Meta分析

Tubeless versus standard percutaneous nephrolithotomy in treating upper urinary tract stones in China: a meta-analysis

目的系统评价国内成人无管化与标准化经皮肾镜取石术两种手术方式治疗上尿路结石的安全性和有效性。方法系统检索Pub Med、EMBASE、Cochrane临床对照试验资料库(CENTRAL)、The ISI Web of Knowledge Databases、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)和维普中文科技期刊数据库(VIP)、万方数据库,并辅以手工检索,检索时间均为建库至2014年3月,查找所有研究比较无管化和标准化经皮肾镜取石术(PCNL)治疗上尿路结石的随机对照试验(RCT),按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价,采用Re Man 5.1软件进行Meta分析。结果共纳入8项研究,661例患者。Meta分析结果显示:与标准化PCNL相比,无管化PCNL缩短手术时间、住院时间、术后重返工作时间以及术后漏尿时间,降低术后疼痛评分,减少镇痛药物需求病例数,减少镇痛药物使用量,而结石清除率、尿外渗、术后发热病例、术后血红蛋白下降量、大出血发生率以及术后输血病例方面无差异。结论基于目前所纳入的随机对照试验,无管化与标准化经皮肾镜取石术两种术式相比,在手术时间、住院时间,术后疼痛等方面存在优势,而在结石清除率、大出血、术后发热等方面并无明显差异,可以看出无管化经皮肾镜是有效、安全、经济的上尿路结石治疗手段。但由于该系统评价纳入研究数量少,原始研究质量较低,且有存在选择偏倚、实施偏倚与发表偏倚的可能性,需要更多高质量、大样本的随机对照试验提供更可靠的证据,建议临床严格把握适应证,选择性的使用相应术式。

Objective To evaluate the clinical therapeutic efficacy and safety of tubeless versus standard percutaneous nephrolithotomy（PCNL） in treating upper urinary tract stones in China. Methods We searched Pub Med,EMbase, Cochrane Central Register of Controlled Trials（CENTRAL）, the ISI Web of Knowledge databases, CBM,CNKI, VIP and Wanfang without language restriction from their establishment to March 2014 for collecting the randomized controlled trials（RCTs） about tubeless versus standard PCNL for the treatment of upper urinary tract stones,and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, Cochrane Collaboration＇s Rev Man 5.1 software was used for statistical analysis. Results Eight studies involving 661 patients were included. Meta-analysis showed that compared with the standard PCNL, tubeless PCNL had shorter operative time, hospital stay, time to return to work after surgery, postoperative urinary leakage time and less postoperative pain scores（VAS scores）, analgesic drug demand, but no significant difference was found with regard to stone clearance rate, urinary extravasation, fever, hemoglobin decreased, amount of bleeding and transfusion. Conclusion The current evidence indicates that the clinical efficacy and safety of tubeless standard PCNL have no statistically significant difference in all measurements. Compared with standard PCNL,tubeless PCNL could reduce hospital stay and postoperative analgesia requirement without increasing other complications. Because of the small number of the included studies, which weakens the strength of the evidence of our results,there is a moderate possibility of selection bias, performance bias and publication bias in this review. More high-quality and large-sample studies are needed to provide further evidences.