一期斜仰截石位双镜联合与经皮肾镜治疗复杂性肾结石的Meta分析

Percutaneous nephrolithotomy in one-stage oblique supine lithotomy position combined with flexible ureteroscopy for complex nephrolithiasis:a Meta-analysis

目的 探讨一期斜仰截石位经皮肾镜联合输尿管软镜与否治疗复杂性肾结石的的有效性与安全性。方法 检索PubMed、Embase、Cochrane Library、Web of science、CNKI、VIP、CBM、万方数据库,搜集关于一期斜仰截石位经皮肾镜联合输尿管软镜与俯卧位经皮肾镜取石术治疗复杂性肾结石的随机对照试验。利用RevMan 5.4、Stata 16.0软件进行Meta分析。结果 共纳入11篇文献,1 029例患者(双镜组511例,对照组518例)。Meta分析结果表明,双镜组较对照组一期结石清除率高(RR=1.24,95%CI:1.16~1.32,P<0.001)、总体并发症发生率低(RR=0.49,95%CI:0.41~0.58,P<0.001)、术后感染率低(RR=0.52,95%CI:0.31~0.87,P=0.010)、出血率低(RR=0.43,95%CI:0.22~0.82,P=0.010)、输血率低(RR=0.34,95%CI:0.13~0.91,P=0.030)、住院时间短(MD=-1.57,95%CI:-2.60~-0.55,P=0.003)、术中出血量少(MD=-52.09,95%CI:-97.71~-6.47,P=0.030)。在最终结石清除率、手术时间、术后发热率差异均无统计学意义(P>0.05)。结论 一期斜仰截石位双镜联合具有一期结石清除率高,总体并发症发病率低,术后感染率、出血率及输血率低,术中出血量少、住院时间短等多方面优势。

Objective To investigate the efficacy and safety of percutaneous nephroscopy in one-stage oblique supine lithotomy position combined with flexible ureteroscopy in the treatment of complex nephrolithiasis.Methods Databases such as PubMed,Embase,Cochrane Library,Web of science,CNKI,VIP,CBM,Wanfang were retrieved,to collect randomized controlled trials of percutaneous nephrolithotomy in one-stage oblique supinelithotomy position combined with flexible ureteroscopy and percutaneous nephrolithotomy in prone position for complex nephrolithiasis.RevMan 5.4 and Stata 16.0 software were used for Meta-analysis.Results A total of 11 articles and 1 029 patients(511 in the double mirror group and 518 in the control group) were included.Meta-analysis results showed that,compared with the control group,the double mirror group had a higher clearance rate of primary stone(RR=1.24,95%CI:1.16-1.32,P<0.001),and a lower overall complication rate(RR=0.49,95%CI:0.41-0.58,P<0.001),lower postoperative infection rate(RR=0.52,95%CI:0.31-0.87,P=0.010),lower bleeding rate(RR=0.43,95%CI:0.22-0.82,P=0.010),lower blood transfusion rate(RR=0.34,95%CI:0.13-0.91,P=0.030),shorter length of hospital stay(MD=-1.57,95%CI:-2.60--0.55,P=0.003),and less intraoperative blood loss(MD=-52.09,95%CI:-97.71--6.47,P=0.030).There was no significant difference in the final stone clearance rate,duration of operation,and postoperative fever rate.Conclusion Percutaneous nephroscopy in one-stage oblique supine lithotomy position combined with double endoscopy has many advantages,such as high one-stage stone clearance rate,low overall complication rate,low postoperative infection rate,low bleeding rate and blood transfusion rate,less intraoperative blood loss,and shorter length of hospital stay.