Xiao Kaiwen, Zhou Liang, Zhu Shiyu, Lin Lede, Di Xingpeng, Li Hong
Department of Urology/Institute of Urology, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2023 Mar 15;10:1063159. doi: 10.3389/fsurg.2023.1063159. eCollection 2023.
To explore the optimal frequency for pediatric extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary stones.
A systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before January 2023. Primary outcomes were perioperative efficacy parameters, including ESWL time, anesthesia time for ESWL sessions, success rates after each session, additional interventions needed, and treatment sessions per patient. Secondary outcomes were postoperative complications and efficiency quotient.
Four controlled studies involving 263 pediatric patients were enrolled in our meta-analysis. In the comparison between the low-frequency and intermediate-frequency groups, we observed no significant difference as regards anesthesia time for ESWL session (WMD = -4.98, 95% CI -21.55∼11.58, = 0.56), success rates after ESWL sessions (first session: OR = 0.02 95%CI -0.12∼0.17, = 0.74; second session: OR = 1.04 95%CI 0.56∼1.90, = 0.91; third session: OR = 1.62 95%CI 0.73∼3.60, = 0.24), treatment sessions needed (WMD = 0.08 95%CI -0.21∼0.36, = 0.60), additional interventions after ESWL (OR=0.99 95%CI 0.40∼2.47, = 0.99) and rates of Clavien grade 2 complications (OR = 0.92 95%CI 0.18∼4.69, = 0.92). However, the intermediate-frequency group may exhibit potential benefits in Clavien grade 1 complications. In the comparison between intermediate-frequency and high-frequency, the eligible studies exhibited higher success rates in the intermediate-frequency group after the first session, the second session and the third session. More sessions may be required in the high-frequency group. With respect to other perioperative, postoperative parameters and major complications, the results were similar.
Intermediate-frequency and low-frequency had similar success rates and seemed to be the optimal frequency for pediatric ESWL. Nevertheless, future large-volume, well-designed RCTs are awaited to confirm and update the findings of this analysis.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42022333646.
探讨小儿体外冲击波碎石术（ESWL）治疗上尿路结石的最佳频率。
通过检索PubMed、Embase、Web of Science和Cochrane对照试验中央注册库数据库进行系统文献检索，以识别2023年1月前发表的符合条件的研究。主要结局为围手术期疗效参数，包括ESWL时间、每次ESWL治疗的麻醉时间、每次治疗后的成功率、所需的额外干预措施以及每位患者的治疗次数。次要结局为术后并发症和效率商数。
四项涉及263例儿科患者的对照研究纳入了我们的荟萃分析。在低频组和中频组的比较中，我们观察到ESWL治疗的麻醉时间（加权均数差[WMD]= -4.98，95%可信区间[-21.55，11.58]，P = 0.56）、ESWL治疗后成功率（首次治疗：比值比[OR]= 0.02，95%可信区间[-0.12，0.17]，P = 0.74；第二次治疗：OR = 1.04，95%可信区间[0.56，1.90]，P = 0.91；第三次治疗：OR = 1.62，95%可信区间[0.73，3.60]，P = 0.24）、所需治疗次数（WMD = 0.08，95%可信区间[-0.21，0.36]，P = 0.60）、ESWL治疗后的额外干预措施（OR = 0.99，95%可信区间[0.40，2.47]，P = 0.99）以及Clavien 2级并发症发生率（OR = 0.92，95%可信区间[0.18，4.69]，P = 0.92）方面无显著差异。然而，中频组在Clavien 1级并发症方面可能显示出潜在益处。在中频组和高频组的比较中，符合条件的研究显示中频组在首次治疗、第二次治疗和第三次治疗后成功率更高。高频组可能需要更多治疗次数。关于其他围手术期、术后参数和主要并发症，结果相似。
中频和低频的成功率相似，似乎是小儿ESWL的最佳频率。然而，期待未来有大规模、设计良好的随机对照试验来证实和更新本分析的结果。
