经皮肾镜取石术中单探头双能碎石机的评估：一项对临床前和临床研究的系统评价与荟萃分析
Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies.
作者信息
Mykoniatis Ioannis, Pyrgidis Nikolaos, Tzelves Lazaros, Pietropaolo Amelia, Juliebø-Jones Patrick, De Coninck Vincent, Hameed Belthangady M Zeeshan, Chaloupka Michael, Schulz Gerald Bastian, Stief Christian, Kallidonis Panagiotis, Somani Bhaskar K, Skolarikos Andreas
机构信息
First Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands.
出版信息
World J Urol. 2023 Feb;41(2):551-565. doi: 10.1007/s00345-023-04278-2. Epub 2023 Jan 19.
PURPOSE
To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis.
METHODS
We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631).
RESULTS
We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82 min, 95% CI -7.31-12.95, I = 78%) and postoperative complications based on the Clavien-Dindo classification.
CONCLUSIONS
SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.
目的
通过系统评价和荟萃分析，评估单探头双能量（SPDE）碎石机在接受经皮肾镜取石术（PCNL）患者中的安全性和有效性。
方法
我们检索了截至2022年7月的PubMed、Cochrane图书馆、Scopus和Embase数据库，以查找任何临床前或临床研究，探讨不同SPDE碎石机在接受PCNL患者中的安全性和有效性。我们进行了荟萃分析，以比较SPDE碎石机与其他碎石机之间的无石率、出血或其他并发症以及平均手术时间（PROSPERO：CRD42021285631）。
结果
我们在系统评价中纳入了16项研究（6项临床前研究、7项观察性研究和3项随机对照研究，共625名参与者），在荟萃分析中纳入了4项研究。临床前研究表明，SPDE碎石机在治疗肾结石方面是安全有效的。在临床研究中，4项研究评估了Trilogy但没有比较组，2项研究将Trilogy或ShockPulse与双探头双能量碎石机进行了比较，2项研究将Trilogy与激光进行了比较，1项研究将ShockPulse与气压弹道碎石机进行了比较，1项研究直接将Trilogy与ShockPulse进行了比较。将SPDE碎石机与其他碎石机进行比较，在无石率（OR 1.13，95%CI 0.53-2.38，I=0%）、术后输血（OR 1.33，95%CI 0.34-5.19，I=0%）、栓塞（OR 0.45，95%CI 0.02-12.06）、手术时间（WMD：2.82分钟，95%CI -7.31-12.95，I=78%）以及基于Clavien-Dindo分类的术后并发症方面均未显示出显著差异。
结论
对于需要进行PCNL的患者，SPDE碎石机是一种有前景的治疗方式。尽管临床前和个别临床研究最初有令人鼓舞的发现，但与 older generation devices相比，Trilogy或ShockPulse似乎提供了相似的效率。 （注：原文中“older generation devices”未明确具体所指，可能是旧一代碎石设备之类的意思，此处保留英文未翻译）
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