Mao Tie, Wei Na, Yu Jing, Lu Yinghui
First Operating Room, The First Hospital of Jilin University, Changchun, China.
Third Operating Room, The First Hospital of Jilin University, Changchun, China.
J Int Med Res. 2021 Jan;49(1):300060520983136. doi: 10.1177/0300060520983136.
We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm.
We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals.
We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL.
LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.
我们旨在比较腹腔镜肾盂切开取石术（LPL）与经皮肾镜取石术（PCNL）治疗直径大于2 cm肾结石的疗效和安全性。
我们检索了PubMed、Embase、Web of Science、中国生物医学文献数据库和中国知网数据库，以查找比较LPL和PCNL手术结果的研究。我们对检索到的研究进行了荟萃分析，以加权平均差或风险比及95%置信区间表示。
我们纳入了25项研究（1831例患者）。与PCNL相比，LPL的结石清除率显著更高，失血率、辅助治疗率、输血率和并发症发生率更低，血红蛋白水平下降更少。LPL和PCNL在住院时间、中转率、肾小球滤过率和肌酐水平变化以及术后平均镇痛时间方面相似。然而，LPL的手术时间比PCNL长。
与PCNL相比，LPL通过提高结石清除率、减少失血、辅助治疗、输血和并发症，在治疗大肾结石患者方面似乎更有效、更安全。因此，LPL可能是治疗大肾结石患者的一种有用方法。
