Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Nursing, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Scand J Surg. 2021 Sep;110(3):301-311. doi: 10.1177/1457496920920474. Epub 2020 Jun 3.
To compare the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in order to determine the optimal tract size for patients with renal stones.
A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through 20 August 2019, reporting on a comparison of the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Of 763 studies, 14 were considered for the evidence synthesis. A total of 1980 cases were included. Of these patients, 897 cases underwent standard percutaneous nephrolithotomy, and 1083 cases underwent mini-percutaneous nephrolithotomy. Stone-free rates were 87.6% (786 of 897 patients) for standard percutaneous nephrolithotomy and 87.8% (951 of 1083 patients) for mini-percutaneous nephrolithotomy ( = 0.57). Tract sizes of 30F and 22-26F in standard percutaneous nephrolithotomy group shorten operation time compared with mini-percutaneous nephrolithotomy ( = 0.02; = 0.004; respectively). Leakage ( = 0.04), bleeding ( = 0.01), blood transfusion ( < 0.00001), and renal pelvis perforation ( = 0.02) were more common in standard percutaneous nephrolithotomy group than in mini-percutaneous nephrolithotomy group. Subgroup analysis showed only blood transfusion for 30F and 22-26F standard percutaneous nephrolithotomy group was more common than mini-percutaneous nephrolithotomy ( < 0.0001, = 0.005, respectively).
Standard percutaneous nephrolithotomy was associated with higher leakage, bleeding, blood transfusion, and renal pelvis perforation, but had a shorter operation time. Tract size of 30F improved the stone-free rate compared with mini-percutaneous nephrolithotomy, but led to more complications. Tract size of 22-26F was no better than 30F or mini-percutaneous nephrolithotomy.
比较标准经皮肾镜碎石术和微经皮肾镜碎石术，以确定肾结石患者的最佳通道大小。
系统检索了 Web of Science、EMBASE、Cochrane 图书馆和 PubMed 数据库，检索时间截至 2019 年 8 月 20 日，报道了使用系统评价和荟萃分析首选报告项目比较标准经皮肾镜碎石术和微经皮肾镜碎石术的文章。
在 763 项研究中，有 14 项被认为具有证据合成价值。共有 1980 例患者纳入研究。其中，897 例行标准经皮肾镜碎石术，1083 例行微经皮肾镜碎石术。标准经皮肾镜碎石术的结石清除率为 87.6%（897 例中有 786 例），微经皮肾镜碎石术的结石清除率为 87.8%（1083 例中有 951 例）（ = 0.57）。标准经皮肾镜碎石术组 30F 和 22-26F 通道大小与微经皮肾镜碎石术相比，手术时间更短（ = 0.02； = 0.004；分别）。标准经皮肾镜碎石术组漏尿（ = 0.04）、出血（ = 0.01）、输血（ < 0.00001）和肾盂穿孔（ = 0.02）更为常见，而微经皮肾镜碎石术组则较少见。亚组分析显示，只有标准经皮肾镜碎石术 30F 和 22-26F 组输血更为常见（ < 0.0001， = 0.005）。
标准经皮肾镜碎石术与较高的漏尿、出血、输血和肾盂穿孔相关，但手术时间更短。与微经皮肾镜碎石术相比，30F 通道大小可提高结石清除率，但会导致更多并发症。22-26F 通道大小并不优于 30F 或微经皮肾镜碎石术。
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