部分无管化经皮肾镜取石术治疗上尿路结石安全性和疗效的荟萃分析

The efficacy and safety of partial tubeless percutaneous nephrolithotomy in the treatment of upper urinary calculus:a Meta-analysis

目的系统评价部分无管化PCNL与传统PCNL治疗上尿路结石的安全性和疗效。方法计算机检索PubMed、Embase、The CochraneLibrary、CNKI、CBM、VIP及万方数据库,全面收集有关的部分无管化经皮肾镜取石术治疗上尿路结石的随机对照研究(RCT),检索时限为1984年1月至2017年11月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.3软件进行荟萃分析。结果共纳入31篇研究、2 408例患者。根据肾造瘘管直径分为小(F8~9)、中(F14~18)、大(F20~24)孔3个亚组,结果显示:在漏尿、术后24h视觉模拟(VAS)疼痛评分、住院时间方面部分无管组与小孔组无统计学差异;在漏尿[OR=0.20,95%CI(0.10~0.41),P<0.01]、术后24hVAS疼痛评分[MD=-1.72,95%CI(-2.18^-1.25),P<0.01],住院时间[MD=-1.80,95%CI(-2.21^-1.39),P<0.01]、重返工作时间[MD=-6.40,95%CI(-8.35^-4.44),P<0.01]、术后镇痛药物需要率[OR=0.26,95%CI(0.17~0.38),P<0.01]方面部分无管化组优于中孔组;在术后24hVAS疼痛评分[MD=-1.12,95%CI(-2.19~0.05),P=0.04]、住院时间[MD=-1.63,95%CI(-2.19^-1.07),P<0.01]方面部分无管化组优于大孔组;小、中、大孔组结石清除率、术后血红蛋白下降量、发热、输血方面,部分无管组与传统组差异无统计学意义。结论部分无管化PCNL术是安全、有效的,与传统PCNL相比,可缩短住院时间、减轻患者术后疼痛不适、降低漏尿发生率、快速康复,建议在临床推广应用。

Objective To evaluate the safety and efficacy of partial tubeless percutaneous nephrolithotomy （PCNL） ver-sus traditional PCNL in the treatment of upper urinary calculus. Methods Relevant randomized controlled trials were identi-fied from databases of PubMed,Embase, The Cochrane Library, CNKI, CBM, VIP and Wanfang. The retrieval time span was from Jan. 1984 to Nov. 2016. The studies were screened according to the inclusion and exclusion criteria,the date were extrac-ted,and the quality was evaluated by 2 reviewers independently. After that, a meta-analysis was conducted using RevMan 5.3 software. Results A total of 31 studies were included,with 2 408 cases involved. The patients were divided into 3 groups：small group （F8-9） ,medium group （F14-18） and large group （F20-24） according to the diameter of nephrostomy tube. The meta-analyses showed：No statistically significant differences were found between partial tubeless group and small group in urinary leakage,pain scores at 24 h and hospital stay. In comparison with medium group,partial tubeless group showed significantly fe--wer urinary leakage rate [OR=0.20,95%CI（0.10-0.41）,P〈0.01],lower postoperative pain scores at 24 h [MD=-1.72, 95%CI（ 2.18- -1.25）,P〈0.01],shorter hospitalstay [MD=-1.80,95%CI （-2.21- -1.39）,P〈0.01],shorter in-stauration work time E MD 6.40,95 ~ CI（ 8.35 4.44）, P%0. 011 and less postoperative analgesia requirement E OR=0.26,95%CI（0.17 0.38）,P〈0.0l].In comparison with large group,the partial tubeless group showed significantly lower painscoresat24h[MD 1.12,95%CI（ -2,19 -0.05）,P=0.04]and shorter hospital stay[MD=-1.63,95%CI（ -2.19 - - 1.07）, P〈0. 01]. No statistically significant differences were observed in stone clearance free, postoperative changes of hemoglobin,fever and transfusion between the partial tubeless group and the nephrostomy tube groups. Conclusion Partial tubeless PCNL is safe and effective. It has advantages over traditional PCNL as it can shorten the hospital stay, reduce postoper-ative pain, lower urine leakage and facilitate recovery.