Xun Yang, Wang Qing, Hu Henglong, Lu Yuchao, Zhang Jiaqiao, Qin Baolong, Geng Yudi, Wang Shaogang
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, China.
Reproductive medicine center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMC Urol. 2017 Nov 13;17(1):102. doi: 10.1186/s12894-017-0295-2.
To update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).
A systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.
Fourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], -3.79 min; 95% confidence interval [CI], -6.73 to -0.85; P = 0.012; I = 53.8%), shorter hospital stay (WMD, -1.27 days; 95% CI, -1.65 to -0.90; P < 0.001; I = 98.7%), faster time to return to normal activity (WMD, -4.24 days; 95% CI, -5.76 to -2.71; P < 0.001; I = 97.5%), lower postoperative pain scores (WMD, -16.55 mm; 95% CI, -21.60 to -11.50; P < 0.001; I = 95.7%), less postoperative analgesia requirements (standard mean difference, -1.09 mg; 95% CI, -1.35 to -0.84; P < 0.001; I = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, -0.02 g/dL; 95% CI, -0.04 to 0.01; P = 0.172; I = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.
Tubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.
更新先前发表的关于无管经皮肾镜取石术（PCNL）疗效和安全性的系统评价及荟萃分析。
对EMBASE、PubMed、Web of Science和Cochrane图书馆进行系统文献检索以确认相关研究。按照预定的纳入和排除标准筛选科学文献。在对符合条件的研究进行质量评估和数据提取后，使用Stata SE 12.0进行荟萃分析。
纳入14项涉及1148例患者的随机对照试验（RCT）。综合结果表明，无管PCNL与手术时间显著缩短（加权平均差[WMD]，-3.79分钟；95%置信区间[CI]，-6.73至-0.85；P = 0.012；I² = 53.8%）、住院时间缩短（WMD，-1.27天；95% CI，-1.65至-0.90；P < 0.001；I² = 98.7%）、恢复正常活动时间更快（WMD，-4.24天；95% CI，-5.76至-2.71；P < 0.001；I² = 97.5%）、术后疼痛评分更低（WMD，-16.55 mm；95% CI，-21.60至-11.50；P < 0.001；I² = 95.7%）、术后镇痛需求更少（标准化平均差，-1.09 mg；95% CI，-1.35至-0.84；P < 0.001；I² = 46.8%）以及漏尿更少（相对风险[RR]，0.30；95% CI 0.15至0.59；P = 0.001；I² =
41.2%）相关。术后血红蛋白降低（WMD，-0.02 g/dL；95% CI，-0.04至0.01；P = 0.172；I² = 41.5%）、结石清除率（RR，1.01；95% CI，0.97至1.05；P = 0.776；I² = 0.0%）、术后发热率（RR，1.05；95% CI，0.57至1.93；P = 0.867；I² = 0.0%）或输血率（RR，0.79；95% CI，0.36至1.70；P = 0.538；I² = 0.0%）无显著差异。亚组分析结果与总体结果一致。敏感性分析表明，分别排除全无管或部分无管或迷你PCNL研究时，大多数结果保持不变。
在经过仔细评估和挑选的患者中，无管PCNL是一种可行且安全的选择。它与住院时间缩短、恢复正常活动时间更快、术后疼痛评分更低、镇痛需求更少以及漏尿减少等优势显著相关。
