分腿俯卧位经皮肾镜取石术的临床效果meta分析

Clinical effect of percutaneous nephrolithotomy in prone split-leg position:a meta-analysis of cohort studies

目的系统评价分腿俯卧位经皮肾镜取石术(PCNL)的临床效果和安全性,探讨分腿俯卧位的可行性、有效性和优越性。方法计算机检索PubMed、Cochrane Library、Web of Science、CINAHL、Embase、OVID、中国知网、中国生物医学文献数据库、万方数据库、维普数据库中关于分腿俯卧位PCNL的RCT及队列研究,检索时限为建库至2022年8月。按照纳入和排除标准筛选文献,并进行文献质量评价,采用RevMan 5.4软件进行Meta分析。结果Meta分析最终纳入14篇文献,共2477例患者。结果显示,相较于传统俯卧位PCNL,分腿俯卧位PCNL的手术时间[MD=-15.17(-20.47,-9.8),Z=21.23,P<0.01]及住院时间[MD=-1.06(-1.79,-0.32),Z=2.81,P<0.01]短,术中出血量[MD=-15.82(-30.39,-1.26),Z=2.13,P=0.03]及并发症发生率[M-H=0.72(0.57,0.91),Z=2.72,P=0.007]低;相较于斜仰卧位PCNL,分腿俯卧位PCNL所需手术时间短[MD=-23.02(-28.87,-18.17),Z=9.30,P<0.01],但并发症发生率高[M-H=1.78(1.23,2.58),Z=3.07,P=0.002]。而在皮肾通道建立时间[MD=-1.69(-5.58,2.21),Z=0.85,P=0.40]、结石清除率[M-H=1.07(1.00,1.15),Z=1.99,P=0.05]、再手术率[M-H=0.50(0.18,1.36),Z=1.36,P=0.17]方面,暂未发现分腿俯卧位较其他体位差异有统计意义。结论分腿俯卧位PCNL能缩短患者手术时间及住院时间,较传统俯卧位PCNL具有更低的并发症发生率。而在皮肾通道建立时间、结石清除率、再手术率方面与传统俯卧位PCNL相似。

Objective To systematically evaluate the application effect of prone split-leg position and explore the feasibility,effectiveness and advantage of Prone Split-leg Position.Methods Relevant RCTs and cohort Studies about the clinical effects of prone position were identified by a systematic search of several electronic databases,including Pubmed,Web of Science,Embase,Cochrane Library,CBM,CNKI,Wanfang Data and VIP database from inception through Augest,2022.Inclusion and exclusion criteria were used to review and rank the literature.After the evaluation of the quality of included studies,and RevMan 5.4 software was adopted for meta-analysis.Results A total of 14 cohort Studies with 2477 patients were finally included.The results showed that PCNL in prone split-leg position,the operation time(MD=-15.17[-20.47,-9.8],Z=21.23,P<0.01)and hospital stay(MD=-1.06[-1.79,-0.32],Z=2.81,P<0.01)is shorter than traditional prone position and the mean bleeding volume(MD=-15.82[-30.39,-1.26],Z=2.13,P=0.03)and the incidence of complication(M-H=0.72[0.57,0.91],Z=2.72,P=0.007)is lower;Comparing with supine position,the prone split-leg position also has a shorter operation time(MD=-23.02[-28.87,-18.17],Z=9.30,P<0.01 but the incidence of complication(M-H=1.78[1.23,2.58],Z=3.07,P=0.002)is higher;There was no significant difference in the time of establishing the kidney tract(MD=-1.69[-5.58,2.21],Z=0.85,P=0.40)、the stone clearance rate(M-H=1.07[1.0,1.15],Z=1.99,P=0.05)and reoperation rate(M-H=0.50[0.18,1.36],Z=1.36,P=0.17)when the prone split-leg position compares with other operative position.Conclusion The prone split-leg position can shorten the operative time and hospital stay,and the incidence of complication is lower than traditional prone position;The time of establishing the kidney tract、the stone clearance rate and reoperation rate is equivalent to traditional prone position.