Yuan Haichao, Zheng Shuo, Liu Liangren, Han Ping, Wang Jia, Wei Qiang
Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, 610041 Sichuan, People's Republic of China.
Urol Res. 2011 Oct;39(5):401-10. doi: 10.1007/s00240-010-0355-5. Epub 2011 Jan 30.
The objective of this study was to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of tubeless versus standard percutaneous nephrolithotomy (PCNL). Relevant randomized or quasi-randomized controlled trials studies were identified from electronic database (Cochrane CENTRAL, Medline and EMBASE et al.). The retrieval time ended in August 2010. The quality of the included trials was assessed and the data were extracted independently by two reviewers. We divided the participants who received standard PCNL into two subgroups: small tube (4-10 F) group and big tube (14-24 F) group to reduce heterogeneity and bias. Efficacy (hospital stay time, operative time, stone-free rate) and safety (postoperative pain and analgesia requirement, postoperative fever, blood transfusion, urine leakage) were explored by using review manager v5.0. Fourteen randomized controlled trials comprising 776 subjects met the inclusion criteria. Our meta-analysis showed that there were statistically significant differences in hospital stay, postoperative analgesic requirement and urine leakage between tubeless and standard PCNL. In operative time, significant difference was found between tubeless and big tube group. No statistically significant differences were found in stone-free rate, postoperative fever, and blood transfusion between tubeless and standard PCNL. In conclusion, Tubeless PCNL was an effective and safe procedure for treatment of renal stones in selected patients, with shorter hospital stay, less analgesic requirement, lower urine leakage and without increased complications. Patients can receive great benefit from tubeless PCNL and it will become more palatable to patients as well as more cost-effective than standard PCNL in the future.
本研究的目的是进行一项系统评价和荟萃分析，以评估无管经皮肾镜取石术（PCNL）与标准PCNL的疗效和安全性。从电子数据库（Cochrane CENTRAL、Medline和EMBASE等）中检索相关的随机或半随机对照试验研究。检索时间截至2010年8月。由两名评价者独立评估纳入试验的质量并提取数据。我们将接受标准PCNL的参与者分为两个亚组：小管（4-10F）组和大管（14-24F）组，以减少异质性和偏倚。使用Review Manager v5.0探讨疗效（住院时间、手术时间、结石清除率）和安全性（术后疼痛及镇痛需求、术后发热、输血、尿漏）。14项包含776名受试者的随机对照试验符合纳入标准。我们的荟萃分析表明，无管PCNL与标准PCNL在住院时间、术后镇痛需求和尿漏方面存在统计学显著差异。在手术时间方面，无管PCNL与大管组之间存在显著差异。无管PCNL与标准PCNL在结石清除率、术后发热和输血方面未发现统计学显著差异。总之，无管PCNL对于特定患者治疗肾结石是一种有效且安全的方法，具有住院时间短、镇痛需求少、尿漏率低且并发症未增加的特点。患者可从无管PCNL中获益良多，并且未来它将比标准PCNL更受患者欢迎且更具成本效益。
