超微通道经皮肾镜与微通道经皮肾镜治疗肾结石临床疗效的Meta分析

Evaluation on the clinical efficacy and safety of ultra-micro channel percutaneous nephrolithotomy and micro channel percutaneous nephrolithotomy in the treatment of renal calculi:a Meta-analysis

目的系统性评价超微通道经皮肾镜与微通道经皮肾镜碎石术(mPCNL)治疗肾结石的疗效和安全性。方法检索Embase、Pubmed、中国知网、中国生物医学文献数据库、万方、维普、Cochrane Library和欧美临床试验数据库,检索时间从建库起至2021年10月7日,包含的手术方式包括mPCNL(对照组)和超微通道经皮肾镜碎石术[试验组,超小型PCNL(UMP)和超微型PCNL(SMP)];主要结局指标是结石清除率,次要指标有住院时间、手术时间、术后发热、术后疼痛和术后再治疗率。结果在筛除不符的研究后共纳入6篇文献,合计474例患者。Meta分析结果显示:两组的结石清除率、术后再治疗率和手术时间比较,差异均无统计学意义(均P>0.05);而试验组的术后发热(OR=0.33,95%CI:0.14~0.75,P=0.009)、术后疼痛(OR=0.16,95%CI:0.07~0.40,P<0.001)和住院时间(MD=-2.53,95%CI:-4.62~-0.44,P=0.02)均优于对照组。结论超微通道经皮肾镜碎石术与mPCNL对肾结石的治疗效果相当,但mPCNL术后能明显降低术后发热、疼痛和住院时间。

Objective To evaluate the efficacy and safety of ultramicro-channel percutaneous nephrolithotripsy and micro-channel percutaneous nephrolithotripsy(mPCNL)in the treatment of renal stones.Methods The Embase,Pubmed,CNKI,China Biomedical Literature Database,Wanfang,VIP,Cochrane Library and European and American clinical trial databases were searchd from the database establishment to October 7,2021.The procedures included mPCNL(control group)and ultramicro-channel percutaneous nephrolithotripsis[experimental group,ultra-mini PCNL(UMP)and super-mini PCNL(SMP)].The main outcome index was stone clearance,while the secondary indexes were length of hospital stay,operation time,postoperative fever,postoperative pain,and postoperative retreatment rate.Results A total of 6 articles with 474 patients were included after excluding inconsistent studies.The results of Meta-analysis showed that there were no significant differences in stone clearance rate,postoperative retreatment rate and operation time between the two groups(all P>0.05).In the experimental group,postoperative fever(OR=0.33,95%CI:0.14~0.75,P=0.009),postoperative pain(OR=0.16,95%CI:0.07~0.40,P<0.001)and length of hospital stay(MD=-2.53,95%CI:-4.62~-0.44,P=0.02)were better than the control group.Conclusions Ultramicro-channel percutaneous nephrolithotripsy is comparable to mPCNL in the treatment of kidney stones,but mPCNL can significantly reduce postoperative fever,pain and length of hospital stay.