经皮肾镜取石术采用斜仰卧位与俯卧位的比较：一项系统评价和荟萃分析
Oblique supine position versus prone position for percutaneous nephrolithotomy: a systematic review and meta-analysis.
作者信息
Wang Hu, Yang Zhan, Chang Xueliang, Wang Yaxuan, Li Jingdong, Han Zhenwei
机构信息
Department of Urology, Second Hospital of Hebei Medical University, Shijiazhuang, China.
出版信息
Wideochir Inne Tech Maloinwazyjne. 2023 Jun;18(2):244-253. doi: 10.5114/wiitm.2023.126453. Epub 2023 Apr 6.
INTRODUCTION
To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the oblique supine position (OSP) and the prone position (PP).
AIM
To perform a systematic review and meta-analysis to evaluate the efficacy and safety of OSP versus PP for PCNL.
MATERIAL AND METHODS
A systematic literature search of PubMed, Ovid, SCOPUS, and citation lists was conducted to identify eligible comparative studies up to November 2022. All studies comparing OSP versus PP for PCNL were included. Statistical analysis was performed with the Collaboration's Review Manager (RevMan) 5.4 software.
RESULTS
Overall, eight studies were included involving 1185 patients (OSP = 634; PP = 551). There were no statistically significant differences between OSP and PP in age (WMD = -0.95 years; 95% CI: -2.12 to 0.21; p = 0.83) or proportion of male patients (OR = 0.02; 95% CI: -0.03 to 0.08; p = 0.43). We found that OSP was performed more frequently for smaller stone size and patients with higher BMI (WMD = -0.1 cm, 95% CI: -0.18 to -0.02; p = 0.01) and patients with higher BMI (WMD = 0.66 kg/m; 95% CI: 0.29 to 1.03; p = 0.0005). The operation time was shorter in OSP than PP (WMD = -14 min; 95% CI: -27.00 to -1.00; p = 0.03). The reduction of hemoglobin was lower in OSP than PP (WMD = -0.39 g/dl; 95% CI: -0.60 to -0.13; p = 0.03). There was no significant difference in stone-free rate and hospitalization between the two groups (OR = 1.32; 95% CI: 0.98 to 1.78; p = 0.07; WMD = -5.99 h; 95% CI: -17.15 to 5.16; p = 0.29). The overall complications were fewer in OSP than in PP (OR = 0.59; 95% CI: 0.43 to 0.81; p = 0.001), but no difference was observed between the positions with regard to the major complications (Clavien-Dindo score ≥ 3) (OR = 0.76; 95% CI: 0.43 to 1.34; p = 0.35).
CONCLUSIONS
OSP showed non-inferior stone-free rate, blood loss, and hospitalization compared with PP. OSP may be superior in terms of operative time and complications than PP.
引言
比较斜仰卧位（OSP）和俯卧位（PP）经皮肾镜取石术（PCNL）的疗效和安全性。
目的
进行系统评价和荟萃分析，以评估OSP与PP用于PCNL的疗效和安全性。
材料与方法
对PubMed、Ovid、SCOPUS及参考文献列表进行系统文献检索，以确定截至2022年11月符合条件的比较研究。纳入所有比较OSP与PP用于PCNL的研究。使用协作组的Review Manager（RevMan）5.4软件进行统计分析。
结果
总体而言，纳入八项研究，共1185例患者（OSP组 = 634例；PP组 = 551例）。OSP和PP在年龄（加权均数差[WMD] = -0.95岁；95%置信区间[CI]：-2.12至0.21；p = 0.83）或男性患者比例（比值比[OR] = 0.02；95% CI：-0.03至0.08；p = 0.43）方面无统计学显著差异。我们发现，对于较小结石尺寸及较高体重指数（BMI）的患者，更常采用OSP（WMD = -0.1 cm，95% CI：-0.18至-0.02；p = 0.01）以及较高BMI的患者（WMD = 0.66 kg/m；95% CI：0.29至1.03；p = 0.0005）。OSP的手术时间比PP短（WMD = -14分钟；95% CI：-27.00至-1.00；p = 0.03）。OSP血红蛋白降低幅度低于PP（WMD = -0.39 g/dl；95% CI：-0.60至-0.13；p = 0.03）。两组在无石率和住院时间方面无显著差异（OR = 1.32；95% CI：0.98至1.78；p = 0.07；WMD = -5.99小时；95% CI：-17.15至5.16；p = 0.29）。OSP的总体并发症少于PP（OR = 0.59；95% CI：0.43至0.81；p = 0.001），但在主要并发症（Clavien-Dindo评分≥3）方面，两种体位未观察到差异（OR = 0.76；95% CI：0.43至1.34；p = 0.35）。
结论
与PP相比，OSP在无石率、失血和住院方面显示出非劣效性。OSP在手术时间和并发症方面可能优于PP。
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