Li Zhiqin, Wu Aiming, Liu Jianjun, Huang Shuitong, Chen Guangming, Wu Yonglu, Chen Xianxi, Tan Guobin
Department of Urology, Maoming People's Hospital, Maoming 525000, China.
Department of Urology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China.
Transl Androl Urol. 2020 Apr;9(2):210-217. doi: 10.21037/tau.2020.01.10.
The aim of this meta-analysis was to systematically review and identify the risk factors for severe hemorrhage after percutaneous nephrolithotomy (PCNL).
We searched the PubMed and EMBASE database for literature related to the risk factors of severe hemorrhage after PCNL requiring angiography and embolization through to September 2019. The necessary data for each eligible study were extracted by 2 independent reviewers. The Newcastle-Ottawa Scale (NOS) was used for assessing the methodological quality of the included studies. Statistical analyses were conducted using Comprehensive Meta-Analysis version 2 to identify whether there was a statistical association between risk factors and severe hemorrhage post-PCNL.
The results of this meta-analysis showed that urinary tract infection (UTI) (OR =1.98, 95% CI, 1.21-3.26, P=0.007), diabetes mellitus (OR =4.07, 95% CI, 1.83-9.06, P=0.001), staghorn stone (OR =3.49, 95% CI, 1.25-9.76, P=0.017), and multiple tracts (OR =2.09, 95% CI, 1.33-3.28, P=0.001) were independent risk factors for severe hemorrhage post-PCNL, while hypertension (OR =1.18, 95% CI, 0.58-2.42, P=0.65) showed no significant statistical difference.
Urologists should focus on the above identified risk factors for severe hemorrhage post-PCNL, including UTI, diabetes mellitus, staghorn stone, and multiple tracts. More high-quality studies with larger sample sizes are needed to validate these conclusions.
本荟萃分析的目的是系统评价并确定经皮肾镜取石术（PCNL）后严重出血的危险因素。
我们检索了PubMed和EMBASE数据库，以查找与PCNL后需要血管造影和栓塞的严重出血危险因素相关的文献，检索截至2019年9月。由2名独立审阅者提取每项合格研究的必要数据。采用纽卡斯尔-渥太华量表（NOS）评估纳入研究的方法学质量。使用Comprehensive Meta-Analysis 2版进行统计分析，以确定危险因素与PCNL后严重出血之间是否存在统计学关联。
本荟萃分析结果显示，尿路感染（UTI）（比值比[OR]=1.98，95%置信区间[CI]为1.21-3.26，P=0.007）、糖尿病（OR=4.07，95%CI为1.83-9.06，P=0.001）、鹿角形结石（OR=3.49，95%CI为1.25-9.76，P=0.017）和多通道（OR=2.09，95%CI为1.33-3.28，P=0.001）是PCNL后严重出血的独立危险因素，而高血压（OR=1.18，95%CI为0.58-2.42，P=0.65）无显著统计学差异。
泌尿外科医生应关注上述确定的PCNL后严重出血的危险因素，包括UTI、糖尿病、鹿角形结石和多通道。需要更多样本量更大的高质量研究来验证这些结论。
