经皮肾镜与腹腔镜下去顶术治疗单纯性肾囊肿疗效及安全性的Meta分析

Meta-analysis of the efficacy and safety of percutaneous nephrological versus laparoscopic decapitation for simple renal cysts

目的系统评价经皮肾镜下肾囊肿去顶术治疗单纯性肾囊肿的临床疗效及安全性。方法计算机检索(检索时间均为建库至2021年10月)Pubmed、Enmbase、Cochrane library、中国知网、万方、维普、中国生物医学(CBM)等数据库,收集并比较经皮肾镜和腹腔镜下治疗单纯性肾囊肿的临床研究,并对符合纳入标准的文献进行资料提取,利用Cochrane系统评价员手册5.0版进行质量评价,利用Rev Man 5.3统计软件进行Meta分析。结果共纳入10篇符合标准的文献,合计592例患者,按照不同术式将其分为经皮肾镜组(288例)和腹腔镜组(304例)。Meta分析结果显示,经皮肾镜术式的并发症发生率(OR=1.15,95%CI:0.58~2.30,Z=0.40,P>0.05)、有效率(OR=0.96,95%CI:0.45~2.05,Z=0.10,P>0.05)、复发率(OR=0.96,95%CI:0.19~4.90,Z=0.05,P>0.05)与腹腔镜术式比较,差异均无统计学意义,而手术时间(MD=-16.97,95%CI:-26.52~-7.42,Z=3.48,P<0.05)、术中出血量(MD=-15.08,95%CI:-22.63~-7.53,Z=3.92,P<0.05)、术后引流量(MD=43.97,95%CI:15.75~72.19,Z=3.05,P<0.05)、术后拔引流管时间(MD=-0.72,95%CI:-1.09~-0.35,Z=3.82,P<0.05)、住院时间(MD=-1.36,95%CI:-2.06~-0.65,Z=3.78,P<0.05)、治疗费用[(0.65±0.15)万元vs.(1.25±0.35)万元,P<0.05]比较,差异均有统计学意义。结论对于单纯性肾囊肿的治疗,经皮肾镜和腹腔镜下肾囊肿去顶术的疗效相似,经皮肾镜肾囊肿去顶术的手术时间、术中出血量、住院时间和治疗费用上优于腹腔镜,但其术后引流量较多,随着经皮肾镜手术经验的增加,经皮肾镜下行肾囊肿去顶术也是一种可供选择的手术方式。

Objective To systematically evaluate the clinical efficacy and safety of percutaneous nephrolithoscopic renal cyst debulking in the treatment of simple renal cysts.Methods Computer searched(The retrieval time was from the establishment of the database to October 2021)of electronic databases such as Pubmed,Enmbase,Cochrane library,China Knowledge Network,Wanfang,Wipu,and China Biomedicine(CBM).Clinical studies on the treatment of simple renal cysts by percutaneous nephroscopy and laparoscopy were collected and compared.Literatures meeting the inclusion criteria were extracted.Cochrane Systematic Evaluator Manual 5.0 was used for quality evaluation,and Rev Man 5.3 statistical software was used for Meta-analysis.Results A total of 10 literatures meeting the criteria were included,including 592 patients,288 in the percutaneous nephroscopic group and 304 in the laparoscopic group.The results of meta-analysis showed that percutaneous nephroscopy had the complication rate(OR=1.15,95%CI:0.58-2.30,Z=0.40,P>0.05),and effective rate(OR=1.15,95%CI:0.58-2.30),Z=0.40,P>0.05),recurrence rate(OR=0.96,95%CI:0.19-4.90,Z=0.05,P>0.05)compared with laparoscopic surgery,the difference was not statistically significant,and the operation time(MD=-16.97,95%CI:-26.52--7.42,Z=3.48,P<0.05),intraoperative blood loss(MD=-15.08,95%CI:-22.63--7.53,Z=3.92,P<0.05),postoperative drainage volume(MD=43.97,95%CI:15.75-72.19,Z=3.05,P<0.05),postoperative drainage tube extraction time(MD=-0.72,95%CI:-1.09--0.35,Z=3.82,P<0.05),length of hospital stay(MD=-1.36,95%CI:-2.06--0.65,Z=3.78,P<0.05),treatment cost[(0.65±0.15)thousand yuan vs.(1.25±0.35)thousand yuan,P<0.05],the differences were statistically significant.Conclusions For the treatment of simple renal cyst,the efficacy of percutaneous nephroscopy and laparoscopic renal cyst roofing is similar.Percutaneous nephroscopy is superior to laparoscopic in terms of operation time,intraoperative blood loss,length of hospital stay and treatment cost,but its postoperative drainage volume is higher.With the increase of experience in percutaneous nephroscopy,Percutaneous nephroscopic toppling of renal cysts is also an option.