Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
J Endourol. 2023 Mar;37(3):264-272. doi: 10.1089/end.2022.0360.
It has been demonstrated that ultrasound (US)-guided renal collecting system access during percutaneous nephrolithotomy (PCNL) is efficient and secure. The puncture success rate fell to 82%, and the total complication rate rose to 15% in kidneys with nondilated collecting systems. Contrast-enhanced ultrasonography (CEUS) has been used in PCNL techniques to address this issue. We did this meta-analysis following the preferred reporting criteria for systematic reviews and meta-analysis to combine the data of published studies to compare the CEUS-guided PCNL and the standard US-guided PCNL (PRISMA). For relevant literature, we searched PubMed, Embase, Web of Science, CKNI, and the Cochrane Library. The final inclusion date for this meta-analysis was May 1, 2022, and three randomized controlled trials (RCTs) were finally included. RevMan V5.4.1 was used in this work. Standard mean difference (SMD) with a 95% confidence interval (CI) was utilized as the major estimate in the synthesis of continuous data, while odds ratio (OR) with a 95% CI was synthesized as the main estimate in the synthesis of discontinuous data. We found that compared with traditional US-guided PCNL, CEUS-guided PCNL could offer more benefits in terms of single-needle success rate (OR: 3.02, 95% CI: 1.62 to 5.61, = 0.0005), shorter puncture time (SMD: -1.33, 95% CI: -2.06 to -0.60, = 0.0004), shorter hospital stays (SMD: -0.37, 95% CI: -0.60 to -0.13, = 0.002), and a better stone clearance rate (OR: 2.32, 95% CI: 1.15 to 4.68. = 0.02). Although the PCNL complication rate after surgery was not significantly reduced by the CEUS technique (overall complication: OR = 0.70, 95% CI: 0.37 to 1.30, = 0.25. Grade 1/2 complication: OR = 0.79, 95% CI: 0.41 to 1.53, = 0.48; Grade 3/4 complication: OR = 0.44, 95% CI: 0.10 to 1.98, = 0.28), it could reduce hemoglobin dropping compared with conventional US-guided PCNL (SMD: -0.82, 95% CI: -1.06 to -0.58, < 0.001). The CEUS-guided PCNL technique is superior to the US-guided PCNL, according to almost all synthesized data. Additional randomized studies are still required.
已经证明，在经皮肾镜取石术（PCNL）中，超声（US）引导的肾盂集合系统入路是有效和安全的。在无扩张集合系统的肾脏中，穿刺成功率降至 82%，总并发症发生率上升至 15%。对比增强超声（CEUS）已被用于 PCNL 技术来解决这个问题。我们遵循系统评价和荟萃分析的首选报告标准进行了这项荟萃分析，以结合已发表研究的数据，比较 CEUS 引导的 PCNL 和标准 US 引导的 PCNL（PRISMA）。对于相关文献，我们检索了 PubMed、Embase、Web of Science、CKNI 和 Cochrane 图书馆。本荟萃分析的最终纳入日期为 2022 年 5 月 1 日，最终纳入了 3 项随机对照试验（RCT）。本研究使用 RevMan V5.4.1。连续数据的综合采用标准均数差（SMD）和 95%置信区间（CI），不连续数据的综合采用比值比（OR）和 95%CI。我们发现，与传统的 US 引导的 PCNL 相比，CEUS 引导的 PCNL 在单次穿刺成功率（OR：3.02，95%CI：1.62 至 5.61， = 0.0005）、穿刺时间（SMD：-1.33，95%CI：-2.06 至-0.60， = 0.0004）、住院时间（SMD：-0.37，95%CI：-0.60 至-0.13， = 0.002）和结石清除率（OR：2.32，95%CI：1.15 至 4.68. = 0.02）方面具有优势。尽管 CEUS 技术并没有显著降低术后 PCNL 并发症的发生率（总体并发症：OR=0.70，95%CI：0.37 至 1.30， = 0.25. 1/2 级并发症：OR=0.79，95%CI：0.41 至 1.53， = 0.48. 3/4 级并发症：OR=0.44，95%CI：0.10 至 1.98， = 0.28），但与传统的 US 引导的 PCNL 相比，它可以降低血红蛋白的下降（SMD：-0.82，95%CI：-1.06 至-0.58， < 0.001）。CEUS 引导的 PCNL 技术优于 US 引导的 PCNL，几乎所有综合数据都表明了这一点。仍需要更多的随机研究。
