Department of Urology, Zhongnan Hospital, School of Public Health, State Key Laboratory of Virology (YG), Wuhan University, Wuhan, Hubei Province, People's Republic of China.
J Urol. 2013 Sep;190(3):888-93. doi: 10.1016/j.juro.2013.02.092. Epub 2013 Feb 27.
We assessed the effectiveness and safety of laparoscopic pyelolithotomy and percutaneous nephrolithotomy as surgical management for solitary renal pelvic calculi larger than 2 cm.
We searched PubMed®, EMBASE®, The Cochrane Library and the Web of Knowledge(SM) databases up to November 9, 2012 for relevant published studies. After data extraction and quality assessment, meta-analysis was performed using RevMan 5.1.
We identified 7 trials in a total of 176 and 187 patients treated with laparoscopic pyelolithotomy and percutaneous nephrolithotomy, respectively. Operative time and hospital stay were 50.62 minutes and 0.66 days shorter in the nephrolithotomy group (p <0.0001 and 0.04, respectively). Patients in the laparoscopic group benefited from a lesser decrease in hemoglobin (OR -1.00, 95% CI -1.77--0.23), less postoperative fever (OR 0.24, 95% CI 0.08-0.72), a lower incidence of bleeding (OR 0.29, 95% CI 0.10-0.85) and a higher stone-free rate (OR 4.85, 95% CI 1.59-14.82). Sensitivity analysis indicated that all results were stable except the stone-free rate showed no statistically significant difference between the 2 groups (OR 0.33, 95% CI 0.09-1.17). No publication bias was detected.
Current evidence suggests that laparoscopic pyelolithotomy and percutaneous nephrolithotomy are effective and safe for large renal pelvic calculi but laparoscopic pyelolithotomy seems to be more advantageous. However, given the inherent limitations of the included studies, results must be further confirmed in high quality randomized, controlled trials.
我们评估了腹腔镜肾盂切开取石术和经皮肾镜取石术作为大于 2cm 的孤立肾盂结石的手术治疗方法的有效性和安全性。
我们检索了 PubMed®、EMBASE®、The Cochrane Library 和 Web of Knowledge(SM) 数据库，以获取截至 2012 年 11 月 9 日的相关已发表研究。在提取数据和评估质量后，我们使用 RevMan 5.1 进行了荟萃分析。
我们共确定了 7 项研究，共有 176 例和 187 例患者分别接受了腹腔镜肾盂切开取石术和经皮肾镜取石术治疗。经皮肾镜取石术组的手术时间和住院时间分别缩短了 50.62 分钟和 0.66 天（p<0.0001 和 0.04）。腹腔镜组患者的血红蛋白下降幅度较小（OR-1.00，95%CI-1.77-0.23），术后发热较少（OR 0.24，95%CI 0.08-0.72），出血发生率较低（OR 0.29，95%CI 0.10-0.85），结石清除率较高（OR 4.85，95%CI 1.59-14.82）。敏感性分析表明，除结石清除率外，所有结果均稳定，两组间无统计学差异（OR 0.33，95%CI 0.09-1.17）。未发现发表偏倚。
现有证据表明，腹腔镜肾盂切开取石术和经皮肾镜取石术对大的肾盂结石是有效且安全的，但腹腔镜肾盂切开取石术似乎更有优势。然而，鉴于纳入研究的固有局限性，这些结果必须在高质量的随机对照试验中进一步确认。
