Ma Yucheng, Lin Lede, Luo Zhumei, Jin Tao
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.
Department of Oncology, Chengdu Third People's Hospital, Chengdu, Sichuan, China.
Front Surg. 2022 Sep 13;9:930159. doi: 10.3389/fsurg.2022.930159. eCollection 2022.
To evaluate the superior calyceal access's performance and safety in relation to other calyceal access during percutaneous nephrolithotomy (PCNL).
The suggested reporting items for systematic reviews and meta-analysis were used to conduct this meta-analysis (PRISMA). To find pertinent studies for this meta-analysis, we searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI). Operation time and hospital stay are two secondary outcomes, whereas failed stone clearance and complication events are the two major outcomes. Utilizing Stata 15.0, RevMan 5.3, and R 4.0.2, relative data were extracted and evaluated.
This meta-analysis was based on 16 studies with 8,541 individuals. Pooled results suggested that superior calyceal access could offer fewer failed stone clearance [odds ratio (OR): 0.64, 95% confidence interval (CI), 0.47-0.88, = 0.006] and lower additional puncture rate (OR: 0.35, 95% CI, 0.24-0.51, < 0.001) than other calyceal access. No complication difference was found (OR: 1.10, 95% CI, 0.78-1.56, = 0.57). Superior calyceal access could offer shorter operation time [standard mean difference (SMD): -0.57, 95% CI, -0.98 to -0.15, = 0.007]. No hospital stay difference was found (SMD: 0.07, 95% CI, -0.09 to 0.22, = 0.38). Large heterogeneity was detected in stone clearance comparison ( = 71%, < 0.001) and operation time ( = 97%, < 0.001). The stone clearance comparison also identified significant publication bias ( = 0.026). These defects weaken the credibility of the results.
Superior calyceal access in PCNL may result in a higher stone clearance rate, a lower rate of subsequent punctures, and a faster operation duration with no increase in postoperative complications or hospital stay for kidney stone patients, despite the significant heterogeneity and publication bias. By conducting bigger randomized controlled studies, this discovery still has to be confirmed.
评估经皮肾镜取石术（PCNL）中，与其他肾盏入路相比，上肾盏入路的操作性能及安全性。
本荟萃分析采用系统评价与荟萃分析的推荐报告项目（PRISMA）。为查找该荟萃分析的相关研究，我们检索了PubMed、Embase、Web of Science和中国知网（CNKI）。结石清除失败和并发症事件是两个主要结局，手术时间和住院时间是两个次要结局。利用Stata 15.0、RevMan 5.3和R 4.0.2提取并评估相关数据。
本荟萃分析基于16项研究，共8541例个体。汇总结果表明，与其他肾盏入路相比，上肾盏入路的结石清除失败率更低[比值比（OR）：0.64，95%置信区间（CI），0.47 - 0.88，P = 0.006]，额外穿刺率更低（OR：0.35，95% CI，0.24 - 0.51，P < 0.001）。未发现并发症差异（OR：1.10，95% CI，0.78 - 1.56，P = 0.57）。上肾盏入路可缩短手术时间[标准均数差（SMD）：-0.57，95% CI，-0.98至-0.15，P = 0.007]。未发现住院时间差异（SMD：0.07，95% CI，-0.09至0.22，P = 0.38）。在结石清除比较（I² = 71%，P < 0.001）和手术时间（I² = 97%，P < 0.001）方面检测到较大异质性。结石清除比较还发现显著的发表偏倚（P = 0.026）。这些缺陷削弱了结果的可信度。
尽管存在显著的异质性和发表偏倚，但PCNL中上肾盏入路可能使肾结石患者的结石清除率更高、后续穿刺率更低、手术持续时间更快，且术后并发症或住院时间无增加。这一发现仍需通过开展更大规模的随机对照研究来证实。
