Bai Yunjin, Tang Yin, Deng Lan, Wang Xiaoming, Yang Yubo, Wang Jia, Han Ping
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China.
BMC Urol. 2017 Aug 31;17(1):75. doi: 10.1186/s12894-017-0266-7.
Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, laparoscopic pyelolithotomy (LPL) can be used as an alternative management procedure. The aim of present study was to compare LPL and PCNL in terms of efficacy and safety for the management of large renal pelvic stones.
A literature search was performed in Jan 2016 using electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) to identify relevant studies for the meta-analysis. Only comparative studies investigating LPL versus PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).
Five randomized and nine non-randomized studies were identified for analysis, involving a total of 901 patients. Compared with PCNL, LPL provided a significantly higher stone-free rate (OR 3.94, 95% CI 2.06-7.55, P < 0.001), lower blood transfusion rate (OR 0.28, 95% CI 0.13-0.61, P = 0.001), lower bleeding rate (OR 0.20, 95% CI 0.06-0.61, P = 0.005), fewer hemoglobin decrease(MD -0.80, 95% CI -0.97 to -0.63, P < 0.001), less postoperative fever (OR 0.38, 95% CI 0.21-0.68; P = 0.001), and lower auxiliary procedure rate (OR 0.24, 95% CI 0.12-0.46, P < 0.001) and re-treatment rate (OR 0.20, 95% CI 0.07-0.55, P = 0.002). However, LPL had a longer operative time and hospital stay. There were no significant differences in conversion to open surgery and prolonged urine leakage rates between LPL and PCNL.
Our present findings suggest that LPL is a safe and effective approach for management of patients with large renal stones. However, PCNL still suitable for most cases and LPL can be used as an alternative management procedure with good selection of cases.
经皮肾镜取石术（PCNL）仍是治疗大体积（≥2 cm）肾结石的标准术式；然而，腹腔镜肾盂切开取石术（LPL）可作为一种替代治疗方法。本研究旨在比较LPL和PCNL治疗大体积肾盂结石的有效性和安全性。
于2016年1月使用电子数据库（Cochrane对照试验中央注册库、Medline和EMBASE）进行文献检索，以确定纳入荟萃分析的相关研究。仅纳入比较LPL与PCNL的对照研究。效应量通过合并比值比（OR）和平均差（MD）及95%置信区间（CI）进行估计。
共纳入5项随机研究和9项非随机研究进行分析，涉及901例患者。与PCNL相比，LPL的结石清除率显著更高（OR 3.94，95%CI 2.06 - 7.55，P < 0.001），输血率更低（OR 0.28，95%CI 0.13 - 0.61，P = 0.001），出血率更低（OR 0.20，95%CI 0.06 - 0.61，P = 0.005），血红蛋白降低幅度更小（MD -0.80，95%CI -0.97至 -0.63；P < 0.001），术后发热更少（OR 0.38，95%CI 0.21 - 0.68；P = 0.001），辅助手术率更低（OR 0.24，95%CI 0.12 - 0.46，P < 0.001）以及再次治疗率更低（OR 0.20，95%CI 0.07 - 0.55，P = 0.002）。然而，LPL的手术时间和住院时间更长。LPL与PCNL在转为开放手术率和持续性尿漏率方面无显著差异。
我们目前的研究结果表明，LPL是治疗大体积肾结石患者的一种安全有效的方法。然而，PCNL仍适用于大多数病例，LPL可作为一种替代治疗方法，但需严格选择病例。
