GMSV体位与俯卧位在经皮肾镜手术中应用的疗效比较Meta分析

Comparison of GMSV position and prone position in percutaneous nephroscopic surgery:a Meta-analysis

目的系统评价GMSV体位下经皮肾镜取石术与俯卧位经皮肾镜取石术治疗肾结石的有效性和安全性。方法对PubMed、Embase、Cochrane Library数据库进行系统检索,选定所有符合条件的研究,3名作者独立进行文献筛选和数据提取,运用RevMan 5.4软件进行Meta分析。结果共纳入9篇文章,包括7篇随机对照研究、2篇病例对照研究,共1690例患者。Meta分析结果显示,GMSV组经皮肾镜取石术住院时间短于俯卧位组(WMD:-9.04,95%CI:-16.85~-1.22,P=0.02);术中辐射暴露时间短于俯卧位组(WMD:-1.23,95%CI:-1.98~-0.48,P=0.001);总并发症低于俯卧位组(RR:0.72,95%CI:0.59~0.88,P=0.001);两组在手术时间、一期结石清除率、术后血红蛋白丢失量、输血率、发热率和无管化率方面差异无统计学意义。结论GMSV体位下的经皮肾镜取石术相较俯卧位经皮肾镜取石术一期结石清除率相当,但在住院时间、术中辐射时间、总体并发症发生率方面有着显著优势。GMSV体位下的经皮肾镜取石术是治疗肾结石和输尿管上段结石比较安全的选择。

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy in Galdakao-modified supine Valdivia(GMSV)position and prone position in the treatment of renal calculi.Methods PubMed,Embase and Cochrane Library databases were searched systematically to identify all eligible studies.Literature collected were screened and data were extracted by three authors independently.RevMan5.4 software was used for Meta-analysis.Results A total of 9 articles were enrolled,including 7 randomized controlled studies and 2 case-control studies,with a total of 1690 patients.The results of Meta-analysis showed that compared with the prone position group,the GMSV group had shorter hospital stay(WMD:-9.04,95%CI:-16.85--1.22,P=0.02),shorter intraoperative radiation exposure(WMD:-1.23,95%CI:-1.98--0.48,P=0.001),lower rate of complications(RR:0.72,95%CI:0.59-0.88,P=0.001),but there were no significant differences in operation time,primary stone clearance rate,postoperative hemoglobin loss,blood transfusion rate,fever rate and non-tubulization rate.Conclusion Compared with percutaneous nephrolithotomy in prone position,percutaneous nephrolithotomy in GMSV position has the comparable stone clearance rate,but has significant advantages in hospital stay,intraoperative radiation time,and overall complications.It is safe for the treatment of renal stones and upper ureteral stones.