内镜联合肾内手术（ECIRS）与经皮肾镜取石术（PCNL）的安全性和有效性：一项系统评价和荟萃分析。

The Safety and Efficacy of Endoscopic Combined Intrarenal Surgery (ECIRS) versus Percutaneous Nephrolithotomy (PCNL): A Systematic Review and Meta-Analysis.

作者信息

Abdullatif Victor A, Sur Roger L, Abdullatif Ziad A, Szabo Sharon R, Abbott Joel E

机构信息

Urology, Ascension Macomb-Oakland Hospital, Warren 48093, MI, USA.

Urology, University of California San Diego Health, San Diego 92121, CA, USA.

出版信息

Adv Urol. 2022 Jul 18;2022:1716554. doi: 10.1155/2022/1716554. eCollection 2022.

PURPOSE

Our aim is to evaluate the safety and efficacy of endoscopic combined intrarenal surgery compared to percutaneous nephrolithotomy to guide practitioners and inform guidelines.

MATERIALS AND METHODS

A detailed database search was performed in PubMed, OVID, Scopus, and Web of Science in October 2021 to identify articles pertaining to ECIRS published between 2001 and 2021.

RESULTS

Four nonrandomized comparative studies and one RCT were identified, yielding five studies with a total of 546 patients (ECIRS/mini-ECIRS, = 277; PCNL/mini-PCNL, = 269). Subjects in these five studies met the predefined inclusion criteria established by two reviewers (J.E.A. and R.L.S.) and were therefore eligible for analysis. The results demonstrated that ECIRS was associated with a higher SFR (OR: 4.20; 95% CI: 2.79, 6.33; < 0.00001), fewer complications (OR: 0.63; 95% CI: 0.41, 0.97; =0.04), and a shorter hospital stay (WMD: -1.27; 95% CI: -1.55, -0.98; < 0.00001) when compared to PCNL. There were no statistically significant differences in blood transfusions (OR: 0.45; 95% CI: 0.12, 1.68; =0.24), operative time (SMD: -1.05; 95% CI: -2.42, 0.31; =0.13), or blood loss (SMD: -1.10; 95% CI: -2.46, 0.26; =0.11) between ECIRS and PCNL.

CONCLUSIONS

ECIRS may be a more suitable approach for the surgical management of large and complex kidney stones currently indicating PCNL due to its superior efficacy with comparable surgical time and complication rate, though it is thought that a lack of resources and properly trained personnel may preclude ECIRS from becoming the standard. It is our impression that ECIRS may become the preferred technique in the endourologic community corresponding to the evolutionary sequence of percutaneous stone surgery.

目的

我们的目的是评估内镜联合肾内手术与经皮肾镜取石术相比的安全性和有效性，以指导从业者并为指南提供信息。

材料和方法

2021年10月在PubMed、OVID、Scopus和Web of Science中进行了详细的数据库搜索，以识别2001年至2021年间发表的与内镜联合肾内手术相关的文章。

结果

确定了四项非随机对照研究和一项随机对照试验，共五项研究，总计546例患者（内镜联合肾内手术/微型内镜联合肾内手术，=277；经皮肾镜取石术/微型经皮肾镜取石术，=269）。这五项研究中的受试者符合两位审阅者（J.E.A.和R.L.S.）制定的预先定义的纳入标准，因此有资格进行分析。结果表明，与经皮肾镜取石术相比，内镜联合肾内手术的结石清除率更高（比值比：4.20；95%置信区间：2.79，6.33；P<0.00001），并发症更少（比值比：0.63；95%置信区间：0.41，0.97；P=0.04），住院时间更短（加权均数差：-1.27；95%置信区间：-1.55，-0.98；P<0.00001）。内镜联合肾内手术与经皮肾镜取石术在输血（比值比：0.45；95%置信区间：0.12，1.68；P=0.24）、手术时间（标准化均数差：-1.05；95%置信区间：-2.42，0.31；P=0.13）或失血量（标准化均数差：-1.10；95%置信区间：-2.46，0.26；P=0.11）方面无统计学显著差异。