改良仰卧位与俯卧位经皮肾镜疗效的Meta分析

A meta-analysis of the efficacy in modified supine and prone percutaneous nephrolithotomy

目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL的临床对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率及围手术期并发症发生率的数据并进行Meta分析。结果最终纳入18项研究,共2696个病例,Meta分析显示改良仰卧位组的手术时间较俯卧位组缩短(WMD=-19.24,95%CI:-29.09^-9.39,P<0.01),两组在住院时间(WMD=-0.81,95%CI:-0.85~0.41,P=0.59)、结石清除率(OR=0.95,95%CI:0.76~1.19,P=0.65)和围手术期并发症发生率(OR=0.77,95%CI:0.59~1.01,P=0.06)方面差异无统计学意义。结论改良仰卧位行PCNL安全有效,可缩短手术时间,值得推广应用。

Objective To analyzed the safety and efficacy of percutaneous nephrolithotomy （PCNL） in modified supine and prone position. Methods Databases including PubMed, Web of Science, SimoMed, CNKI and Wanfang were searched for clinical controlled studies involved with modified supine and prone PCNL. Studies were enrolled according to inclusion and exclusion criteria. The data of operative time, hospital time, stone-free rate and perioperative complication rate were compared for a Meta-analysis. Results Eighteen studies were eligible, including 2696 cases. The Meta-analysis showed that modified supine PCNL was associated with shorter operative time than prone PCNL （WMD=- 19.24,95%CI： - 29.09-- 9.39, P〈0.01）. There was no significant difference between the two groups regarding hospital time （WMD=-- 0.81, 95% CI： - 0.85~0.41, P=0.59）, stone-free rate （OR=0.95, 95% Ch 0.76-1.19, P=0.65） and perioperative complication rate （OR=0.77, 95% CI： 0.59-1.01, P=0.06）. Conclusion Modified supine PCNL is safe and effective, and better than prone PCNL in operative time.