Wang Jing, Yang Yiqiong, Chen Ming, Tao Tao, Liu Chunhui, Huang Yeqing, Guan Han, Han Xu, Xu Bin
a Department of Urology , Affiliated Zhongda Hospital of Southeast University , Nanjing , China.
Acta Chir Belg. 2016 Dec;116(6):346-356. doi: 10.1080/00015458.2016.1181312. Epub 2016 Aug 10.
To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2 cm.
We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software.
Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I= 0, OR = 0.26 (95% CI 0.10-0.64), p = 0.003], lower drop in hemoglobin level [I=0, difference in mean drop = -0.83 (95% CI -1.05 to -0.61), p < 0.00001] and lower postoperation fever [I=0, OR = 0.36 (95% CI 0.14-0.89), p = 0.03], and PCNL is associated with a lower length of hospital stay [I=74%, difference in mean of hospital stay = 0.72 (95% CI 0.04-1.40), p = 0.04].
LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.
系统评估腹腔镜肾盂切开取石术（LP）与经皮肾镜取石术（PCNL）治疗直径>2 cm肾盂结石的疗效和安全性。
检索PubMed、Embase、Cochrane图书馆和谷歌学术，查找关于LP和PCNL治疗肾结石的文献。检索时间截至2015年9月。两名评价者独立评估所有纳入研究的质量。使用RevMan 5.2软件分析研究中的可用数据。
纳入4项随机对照试验（RCT）和9项非随机同期对照试验（NRCCT），共766例患者。该荟萃分析表明，LP的结石清除率在统计学上高于PCNL[I=0，OR=0.26（95%CI 0.10-0.64），p=0.003]，血红蛋白水平下降更低[I=0，平均下降差值=-0.83（95%CI -1.05至-0.61），p<0.00001]，术后发热更低[I=0，OR=0.36（95%CI 0.14-0.89），p=0.03]，而PCNL的住院时间更短[I=74%，平均住院时间差值=0.72（95%CI 0.04-1.40），p=0.04]。
LP是治疗大型孤立性肾结石的一种选择。LP可能具有更高的结石清除率、更少的失血、更低的术后发热率，而PCNL可能具有更短的住院时间。然而，需要进一步设计良好且大规模的随机对照试验来证实这些发现。
