经皮肾镜碎石术与体外冲击波碎石术治疗中等大小肾结石的比较。

Mini-percutaneous nephrolithotomy versus shock wave lithotripsy for the medium-sized renal stones.

机构信息

Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, University of Sichuan, Chengdu, China.

Department of Urology, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.

出版信息

Minerva Urol Nephrol. 2021 Apr;73(2):187-195. doi: 10.23736/S2724-6051.21.04185-0.

DOI:10.23736/S2724-6051.21.04185-0

PMID:34036766

Abstract

INTRODUCTION

The aim of this study was to assess the clinical outcomes of mini-percutaneous nephrolithotomy (Miniperc) and shock wave lithotripsy (SWL) for medium-sized renal stones.

EVIDENCE ACQUISITION

A literature search was performed in February 2020 using the Pubmed, Web of Science and Embase. The outcome measurements between two procedures were stone-free rates (SFR), complication rates, operative time, hospitalization stay time, re-treatment rate, auxiliary procedures rate and efficiency quotient. Results were pooled by Review Manager version 5.3 software.

EVIDENCE SYNTHESIS

Seven studies on 936 patients (N.=471 for SWL and N.=465 for Miniperc) were included. Miniperc was associated with a higher SFR (OR: 0.25; P<0.00001). In addition, we performed a subgroup analyses for pediatric renal stones and lower pole stones, pooled results also favored Miniperc for higher SFR. SWL was associated with higher auxiliary procedure (OR: 3.32; P<0.00001), higher re-treatment rate (OR: 19.19; P<0.00001) and lower EQ (OR: 0.18; P=0.0003) compared with Miniperc. Besides, SWL was associated with a lower complication rate (OR: 0.36; P=0.0001), shorter operative time (WMD: -34.01; P<0.00001), fluoroscopy time (WMD: -134.48; P<0.00001) and hospital time (WMD: -49.11; P<0.00001) compared with Miniperc.

CONCLUSIONS

Miniperc offers a significantly higher SFR, lower auxiliary procedure and re-treatment rate, but SWL was associated with fewer complications.

摘要

介绍

本研究旨在评估微创经皮肾镜取石术（Miniperc）和体外冲击波碎石术（SWL）治疗中等大小肾结石的临床效果。

证据获取

2020 年 2 月，我们通过 Pubmed、Web of Science 和 Embase 进行了文献检索。两种方法的主要疗效指标是结石清除率（SFR）、并发症发生率、手术时间、住院时间、再次治疗率、辅助治疗率和效率指数。结果通过 Review Manager 版本 5.3 软件进行汇总。

证据综合

共纳入 7 项研究 936 例患者（SWL 组 N=471，Miniperc 组 N=465）。Miniperc 组的 SFR 更高（OR：0.25；P<0.00001）。此外，我们还对儿童肾结石和下极肾结石进行了亚组分析，汇总结果也显示 Miniperc 组的 SFR 更高。SWL 组的辅助治疗率（OR：3.32；P<0.00001）、再次治疗率（OR：19.19；P<0.00001）和效率指数（OR：0.18；P=0.0003）均低于 Miniperc 组。此外，SWL 组的并发症发生率（OR：0.36；P=0.0001）、手术时间（WMD：-34.01；P<0.00001）、透视时间（WMD：-134.48；P<0.00001）和住院时间（WMD：-49.11；P<0.00001）均短于 Miniperc 组。