不同通道经皮肾镜取石术在治疗肾结石的Meta分析

Meta-analysis of Different Channels Percutaneous Nephrolithotomy in the Treatment of Kidney Stones

目的对微通道经皮肾镜取石术(mPCNL)及标准通道经皮肾镜取石术(sPCNL)治疗肾结石的有效性及安全性进行Meta分析。方法计算机检索中文文献数据库CNKI和CBM、英文数据库Web of science和PubMed中的关于mPCNL和sPCNL的病例进行对照研究(CCT)和随机对照研究(RCT)。检索时限为2000年1月1日—2019年12月31日。2名研究员根据纳入和排除标准阅读文献后,各自独立筛选符合条件的12篇研究,并使用Review Manager 5.3版软件进行Meta分析。结果该研究总共纳入1685例病例。在治疗简单肾结石方面,两组的清石率(OR:1.26,95%CI:0.67、2.37,P=0.48)及手术时间(MD:3.15,95%CI:-10.66、16.95,P=0.65)不具有差异性,但mPCNL组比sPCNL组具有更短的平均住院时间(MD:-1.92,95%CI:-2.76、-1.08,P<0.001),更少的术中出血量(MD:-53.38,95%CI:-95.63、-11.14,P=0.01)和血红蛋白下降水平(MD:-0.76,95%CI:-1.07、-0.45,P<0.001),以及更低的并发症发生率(OR:0.48、95%CI:0.36、0.65,P<0.001);而对于复杂肾结石而言,两组的清石率(OR:1.24,95%CI:0.79、1.97,P=0.35)、手术时间(MD:15.34,95%CI:-9.25、39.94,P=0.22)、平均住院时间(MD:-2.08,95%CI:-5.52、1.36,P=0.24)及并发症发生率(OR:1.54,95%CI:0.86,2.74,P=2.74)都不存在差异性。结论在治疗简单肾结石方面,mPCNL组的优势在于具有更短的平均住院时间,更少的术中出血量及更低的并发症发生率;但在治疗复杂肾结石方面,通道大小对治疗效果的影响不显著。

Objective To conduct a Meta-analysis of the effectiveness and safety of micro-channel percutaneous nephrolithotomy(mPCNL)and standard-channel percutaneous nephrolithotomy(sPCNL)in the treatment of kidney stones.Methods A computer search for case-control studies(CCT)and randomized controlled studies(RCT)on mPCNL and sPCNL in Chinese literature databases CNKI and CBM,English databases Web of science and PubMed.The search time limit was from January 1,2000 to December 31,2019.After reading the literature according to the inclusion and exclusion criteria,the two researchers independently screened 12 eligible studies,and used the Review Manager version 5.3 software for meta-analysis.Results A total of 1685 cases were included in this study.In the treatment of simple kidney stones,the rate of stone removal(OR:1.26,95%CI:0.67,2.37,P=0.48)and operation time(MD:3.15,95%CI:-10.66,16.95,P=0.65),there was no difference,but the mPCNL group had a shorter average length of hospital stay(MD:-1.92,95%CI:-2.76,-1.08,P<0.001)and less intraoperative blood loss(MD:-53.38,95%CI:-95.63,-11.14,P=0.01)and decreased hemoglobin levels(MD:-0.76,95%CI:-1.07,-0.45,P<0.001),and a lower incidence of complications(OR:0.48,95%CI:0.36,0.65,P<0.001);for complex kidney stones,the stone removal rate of the two groups(OR:1.24,95%CI:0.79,1.97,P=0.35),operation time(MD:15.34,95%CI:-9.25,39.94,P=0.22),average length of stay(MD:-2.08,95%CI:-5.52,1.36,P=0.24)and complication rate(OR:1.54,95%CI:0.86,2.74,P=2.74)there was no difference.Conclusion In the treatment of simple kidney stones,the advantage of the mPCNL group is that it has a shorter average hospital stay,less intraoperative blood loss and lower complication rate;however,in the treatment of complex kidney stones,the size of the channel has no significant effect on the treatment effect.