Lee Joo Yong, Jeh Seong Uk, Kim Man Deuk, Kang Dong Hyuk, Kwon Jong Kyou, Ham Won Sik, Choi Young Deuk, Cho Kang Su
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea.
BMC Urol. 2017 Jun 27;17(1):48. doi: 10.1186/s12894-017-0239-x.
Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs.
PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane's risk-of-bias assessment tool.
Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14-1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65--0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27-2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23-2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19-1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes.
For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.
经皮肾镜取石术（PCNL）用于治疗相对较大的肾结石。近期发表的文献表明，无管及完全无管（无支架）PCNL在特定患者中是安全的。我们进行了一项系统评价和网状Meta分析，以评估不同PCNL手术方式的可行性和安全性，包括完全无管、带支架无管、小口径管和大口径管PCNL。
检索PubMed、Cochrane对照试验中心注册库和EMBASE™数据库，以识别2013年12月30日前发表的随机对照试验。一名研究人员检查检索到的所有标题和摘要。两名研究人员独立评估全文文章，以确定其是否符合纳入标准。采用Cochrane偏倚风险评估工具对纳入研究的质量进行评分。
最终的综合分析包括成对Meta分析和网状Meta分析，共纳入16项研究。PCNL各手术方式之间的手术时间、疼痛评分和输血率无显著差异。网状Meta分析表明，对于血红蛋白变化，完全无管PCNL可能优于标准PCNL（平均差[MD]0.65，95%可信区间[CI]0.14 - 1.13）和带支架无管PCNL（MD -1.14，95%CI -1.65 - -0.62），小口径PCNL可能优于带支架无管PCNL（MD 1.30，95%CI 0.27 - 2.26）。网状Meta分析还显示，对于住院时间，完全无管（MD 1.33，95%CI 0.23 - 2.43）和带支架无管PCNL（MD 0.99，95%CI 0.19 - 1.79）可能优于标准PCNL。在秩概率检验中，小口径管和完全无管PCNL在手术时间、疼痛评分和血红蛋白变化方面更具优势。
对于血红蛋白变化，完全无管和小口径PCNL可能优于其他方法。对于住院时间，完全无管和带支架无管PCNL可能优于其他手术方式。
