Zhu Ming, Wang Xiaoyi, Shi Zhanqin, Ding Min, Fan Deyong, Wang Xiang, Jiang Rui
Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China.
Nephrology Department, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China.
Exp Ther Med. 2019 Aug;18(2):1366-1374. doi: 10.3892/etm.2019.7710. Epub 2019 Jun 25.
Percutaneous nephrolithotripsy (PCNL) is recommended as the first-line treatment for the management of kidney stones that are ≥2 cm in diameter. Retrograde intrarenal surgery (RIRS) has become increasingly preferred due to its high level of safety and repeatability, particularly in small stones. However, whether PCNL has superior efficacy and lower complication rates when compared with RIRS remains controversial. Therefore, the present meta-analysis was conducted to compare the clinical outcomes of patients treated with PCNL and RIRS as therapy for renal stones. Clinical trials published in PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), and the Chinese Biomedical Database (CBM) were systematically reviewed to evaluate the efficacy and safety profiles of patients with renal stones who were treated with PCNL or RIRS. Main outcomes measures included stone-free rate, operative time, hospital stay, and complication rate. Results were expressed as risk ratio (RR), or weighted mean difference (WMD) with 95% confidence intervals (CIs). Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among the studies. In total, 17 studies [4 randomized controlled trials (RCTs) and 13 cohort studies] involving 1,717 patients met the inclusion criteria, and were included in this meta-analysis. Pooled results showed that PCNL exhibited a significantly higher stone-free rate (RR=0.90, 95% CI: 0.86 to 0.95; P<0.001) but was associated with a longer hospital stay, when compared with RIRS (WMD=-2.72, 95% CI: -3.9 to -1.54; P<0.001). Operative time (WMD=7.86, 95% CI: -0.89 to 16.61; P=0.078) and complication rate (RR=0.71, 95% CI: 0.48 to 1.05; P=0.083) did not significantly differ between the groups. Subgroup analysis revealed that PCNL had a shorter operation time than RIRS in patients with stone sizes ≥2 cm (WMD=12.88, 95% CI: 4.77 to 20.99; P=0.002), and PCNL had a similar stone-free rate as RIRS when the estimates were pooled from RCTs (RR=0.88, 95% CI: 0.76 to 1.01; P=0.078). Compared with PCNL, RIRS had a significantly lower stone-free rate, shorter hospital stay, but a similar operation time and complication rate. Therefore, we propose that RIRS may be an alternative therapy to PCNL, with acceptable efficacy and complication rates for renal stones. Further large-scale, well-conducted RCTs are required to verify our findings.
经皮肾镜取石术（PCNL）被推荐作为直径≥2 cm肾结石治疗的一线方法。逆行性肾内手术（RIRS）因其高安全性和可重复性，尤其在处理小结石时，越来越受到青睐。然而，与RIRS相比，PCNL是否具有更高的疗效和更低的并发症发生率仍存在争议。因此，本荟萃分析旨在比较接受PCNL和RIRS治疗肾结石患者的临床结局。系统回顾了发表于PubMed、科学网、医学文摘数据库（EMBASE）和中国生物医学数据库（CBM）的临床试验，以评估接受PCNL或RIRS治疗的肾结石患者的疗效和安全性。主要结局指标包括结石清除率、手术时间、住院时间和并发症发生率。结果以风险比（RR）或加权平均差（WMD）及95%置信区间（CI）表示。根据研究间的异质性，使用固定效应或随机效应模型计算合并估计值。总共17项研究[4项随机对照试验（RCT）和13项队列研究]涉及1717例患者符合纳入标准，并被纳入本荟萃分析。合并结果显示，与RIRS相比，PCNL的结石清除率显著更高（RR = 0.90，95% CI：0.86至0.95；P < 0.001），但住院时间更长（WMD = -2.72，95% CI：-3.9至-1.54；P < 0.001）。两组间手术时间（WMD = 7.86，95% CI：-0.89至16.61；P = 0.078）和并发症发生率（RR = 0.71，95% CI：0.48至1.05；P = 0.083）无显著差异。亚组分析显示，在结石大小≥2 cm的患者中，PCNL的手术时间比RIRS短（WMD = 12.88，95% CI：4.77至20.99；P = 0.002），并且当从RCT中汇总估计值时，PCNL的结石清除率与RIRS相似（RR = 0.88，95% CI：0.76至1.01；P = 0.078）。与PCNL相比，RIRS的结石清除率显著更低，住院时间更短，但手术时间和并发症发生率相似。因此，我们建议RIRS可能是PCNL的替代疗法，对肾结石具有可接受的疗效和并发症发生率。需要进一步进行大规模、高质量的RCT来验证我们的研究结果。
