Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Urology, Longgang District Central Hospital, Shenzhen, Guangdong, China.
PLoS One. 2019 Jan 31;14(1):e0206810. doi: 10.1371/journal.pone.0206810. eCollection 2019.
To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and open surgery (OS) for surgical treatment of patients with staghorn stones based on published literatures.
A comprehensive literature search of Pubmed, Embase, CNKI and Cochrane Library was conducted to identify studies comparing outcomes of PCNL and OS for treating patients with staghorn stones up to Jan 2018.
There was no significant difference in final-SFR between PCNL and OS (odds ratio[OR]: 1.17; 95% confidence interval [CI]: 0.64, 2.15; p = 0.61), while PCNL provided a significantly lower immediate-SFR compared with OS (OR: 0.29; 95% CI: 0.16, 0.51; P < 0.0001). PCNL provided significantly lower overall complication rate, shorter operative times, hospitalization times, less blood loss and blood transfusion compared with OS (OR: 0.59; 95% CI: 0.41, 0.84; P = 0.004), (weighted mean difference [WMD]: -59.01mins; 95% CI: -81.09, -36.93; p < 0.00001), (WMD: -5.77days; 95% CI: -7.80, -3.74; p < 0.00001), (WMD: -138.29ml; 95% CI: -244.98, -31.6; p = 0.01) and (OR: 0.44; 95% CI: 0.29, 0.68; P = 0.00002), respectively. No significant differences were found in minor complications (Clavien I-II) (OR: 0.72; 95% CI: 0.47, 1.09; p = 0.12) and major complications (Clavien III-V) (OR: 0.5; 95% CI: 0.23, 1.08; P = 0.08). In subgroup analysis, there were no significant differences for overall complications and operative times between mini-PCNL and OS. In sensitivity analysis, there was no significant difference for overall complications between PCNL and OS.
Our analysis suggested that standard PCNL turns out to be a safe and feasible alternative for patients with staghorn stones compared to OS or mini-PCNL. Because of the inherent limitations of the included studies, further large sample, prospective, multi-centric and randomized control trials should be undertaken to confirm our findings.
基于已发表文献，比较经皮肾镜碎石术（PCNL）与开放性手术（OS）治疗鹿角结石患者的疗效和安全性。
系统检索 Pubmed、Embase、中国知网（CNKI）和 Cochrane Library 数据库，收集比较 PCNL 与 OS 治疗鹿角结石患者结局的研究，检索时限均为建库至 2018 年 1 月。
PCNL 组与 OS 组的最终结石清除率（SFR）无显著差异（比值比[OR]：1.17；95%置信区间[CI]：0.64，2.15；p = 0.61），而 PCNL 组即刻 SFR 明显低于 OS 组（OR：0.29；95%CI：0.16，0.51；P < 0.0001）。PCNL 组总的并发症发生率、手术时间、住院时间、出血量和输血量均明显低于 OS 组（OR：0.59；95%CI：0.41，0.84；P = 0.004），（加权均数差[WMD]：-59.01min；95%CI：-81.09，-36.93；p < 0.00001），（WMD：-5.77d；95%CI：-7.80，-3.74；p < 0.00001），（WMD：-138.29ml；95%CI：-244.98，-31.6；p = 0.01）和（OR：0.44；95%CI：0.29，0.68；P = 0.00002），差异均有统计学意义。两组在轻微并发症（Clavien I-II）（OR：0.72；95%CI：0.47，1.09；p = 0.12）和严重并发症（Clavien III-V）（OR：0.5；95%CI：0.23，1.08；P = 0.08）方面差异无统计学意义。亚组分析显示，微通道 PCNL 与 OS 相比，总的并发症和手术时间差异无统计学意义。敏感性分析显示，PCNL 与 OS 之间总的并发症差异无统计学意义。
我们的分析表明，标准 PCNL 是鹿角结石患者一种安全可行的治疗选择，与 OS 或微通道 PCNL 相比。由于纳入研究的固有局限性，需要进一步开展大样本、前瞻性、多中心和随机对照试验来证实我们的发现。
