Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia.
Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia.
F1000Res. 2020 Apr 2;9:231. doi: 10.12688/f1000research.22940.3. eCollection 2020.
The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
在经皮肾镜碎石取石术（PCNL）中，采用仰卧位还是俯卧位仍存在争议。本研究旨在比较仰卧位和俯卧位行 PCNL 的疗效和安全性。
系统地检索了 MEDLINE、Cochrane 图书馆和 Google Scholar 数据库中 2009 年 1 月至 2019 年 11 月的文献。评估的结局指标包括无结石率、主要并发症发生率、住院时间和手术时间的平均值。共有 11 篇文章进行了定性和定量分析。仰卧位 PCNL 的无结石率明显低于俯卧位（OR：0.74；95%CI：0.66-0.83；p<0.00001），但仰卧组的主要并发症发生率也低于俯卧组（OR：0.70；95%CI：0.51-0.96；p=0.03）。两组间住院时间和手术时间的平均值无统计学差异。俯卧位可提高无结石率，但也会增加主要并发症的发生率。因此，PCNL 中采用哪种体位应根据术者的经验和患者的临床情况来决定。
