Department of Urology, University of Patras, Patras, Greece.
Endourology and Lithiasis Working Group, Young Academic Urologists, European Association of Urology, Arnhem, The Netherlands.
Curr Urol Rep. 2021 Dec 16;22(12):65. doi: 10.1007/s11934-021-01079-1.
The purpose of current systematic review and meta-analysis is to determine the efficacy and safety of the administration of tranexamic acid in patients undergoing PCNL. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. This systematic review and meta-analysis includes randomized comparative prospective studies.
The primary endpoints were the hemoglobin drop, the bleeding complications, and the transfusion rate. Secondary endpoints included the operative time, the stone-free rate, the hospital stay, and the overall complications. Two-thousand five-hundred six publications were screened for this study. Six RCTs (1262 patients) were included in the meta-analysis. As for our primary endpoints, the hemoglobin drop was lower in the tranexamic group than in the control group, with mean difference (MD) of - 0.65 (p < 0.0001); the bleeding complications were rarer in the tranexamic group than in the control group, with an odds ratio (OR) of 0.32 (p < 0.00001); and the transfusion rate was lower in the tranexamic group with an OR of 0.34 (p = 0.0007). Concerning the secondary endpoints, the operative time was less in the tranexamic group with an MD of - 10.39 (p < 0.0001), the meta-analysis of the stone-free status data showed no statistical significance between the two groups with an OR of 1.58 (p = 0.09), the hospital stay was significantly less in the tranexamic group with an MD of - 1.38 (p = 0.005), and the overall complications were rarer in the tranexamic group than in the control group with an OR of 0.34 (p = 0.12). The peri-operative use of TA contributes to the reduction of blood loss, bleeding complications, mean operative time, and hospital stay. The use of TA seemed to be safe and well tolerated in patients undergoing PCNL. PROSPERO protocol (Registration number: CRD42019122818).
本系统评价和荟萃分析的目的是确定氨甲环酸在接受经皮肾镜取石术（PCNL）的患者中的疗效和安全性。该研究根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。本系统评价和荟萃分析包括随机对照前瞻性研究。
主要终点是血红蛋白下降、出血并发症和输血率。次要终点包括手术时间、结石清除率、住院时间和总体并发症。本研究共筛选了 2506 篇文献。荟萃分析纳入了 6 项 RCT（1262 名患者）。就我们的主要终点而言，氨甲环酸组的血红蛋白下降低于对照组，平均差异（MD）为-0.65（p<0.0001）；氨甲环酸组的出血并发症较对照组少见，优势比（OR）为 0.32（p<0.00001）；氨甲环酸组的输血率较低，OR 为 0.34（p=0.0007）。关于次要终点，氨甲环酸组的手术时间较短，MD 为-10.39（p<0.0001），荟萃分析两组的结石清除状态数据无统计学意义，OR 为 1.58（p=0.09），氨甲环酸组的住院时间明显较短，MD 为-1.38（p=0.005），氨甲环酸组的总体并发症较对照组少见，OR 为 0.34（p=0.12）。围手术期使用 TA 有助于减少出血量、出血并发症、平均手术时间和住院时间。在接受 PCNL 的患者中，TA 的使用似乎是安全且耐受良好的。PROSPERO 方案（注册号：CRD42019122818）。
