Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil.
Ninth of July University, Av. Dom Jaime de Barros Câmara, 90, Sao Bernardo do Campo, SP, 09895-400, Brazil.
BMC Urol. 2024 Nov 30;24(1):262. doi: 10.1186/s12894-024-01660-z.
Percutaneous nephrolithotomy (PCNL) is widely performed as the preferred treatment for kidney stones larger than 20 mm in pediatric patients, with current research focusing on comparing outcomes between prone and supine positions to determine optimal procedural positioning. Therefore, the aim of this study is to compare the efficacy of prone versus supine positioning in pediatric PCNL, providing clarity on this critical aspect of the procedure to guide clinical decision-making.
We conducted a systematic review in PubMed, Embase, Scopus, Cochrane, Web of Science and Google Scholar. We included studies that compared PCNL in prone vs supine positions for pediatric patients. Our primary outcome was stone-free rate (SFR). Secondary outcomes included operative time, length of hospital stay and overall complications rate. The statistical analysis was performed using Review Manager 5.4.
We retrieved 8 articles, with 269 patients in the prone group and 223 patients in the supine group. The mean age of all patients was 7.92 years old. Our findings presented no statistically significant difference in SFR between the two positions (OR 0.67; CI95 0.38, 1.18; p = 0.17; I = 0%). Additionally, we noted a significant reduction in operative time in the supine position group (MD 13.75; CI95 4.35, 23.15; p = 0.004; I = 84%). At the same time, the length of hospital stay after the procedure was lower in supine group (MD 0.61; CI95 0.34, 0.88; p < 0.0001; I = 21%). No difference was observed regarding the total complication rate (OR 1.47; CI95 0.88, 2.47; p = 0.15; I = 0%).
Our meta-analysis suggests that PCNL performed in the prone position is equivalent to supine PCNL in terms of SFR. However, mainly in the RCT studies, we could observe benefits of the supine position in comparison of prone position in terms of lower operative time, as well as a reduced postoperative hospital stay.
经皮肾镜碎石术（PCNL）被广泛应用于治疗大于 20mm 的肾结石，目前的研究主要集中在比较俯卧位和仰卧位的治疗效果，以确定最佳的手术体位。因此，本研究旨在比较俯卧位与仰卧位在小儿 PCNL 中的疗效，为该手术的关键方面提供明确的信息，以指导临床决策。
我们在 PubMed、Embase、Scopus、Cochrane、Web of Science 和 Google Scholar 进行了系统综述。我们纳入了比较小儿 PCNL 中俯卧位与仰卧位的研究。主要结局为结石清除率（SFR）。次要结局包括手术时间、住院时间和总并发症发生率。统计分析采用 Review Manager 5.4 进行。
我们共检索到 8 篇文章，其中俯卧位组 269 例，仰卧位组 223 例。所有患者的平均年龄为 7.92 岁。我们的研究结果显示，两种体位的 SFR 无统计学差异（OR 0.67；95%CI95 0.38, 1.18；p=0.17；I=0%）。此外，我们发现仰卧位组的手术时间明显缩短（MD 13.75；95%CI95 4.35, 23.15；p=0.004；I=84%）。同时，仰卧位组术后住院时间较短（MD 0.61；95%CI95 0.34, 0.88；p<0.0001；I=21%）。两组总并发症发生率无差异（OR 1.47；95%CI95 0.88, 2.47；p=0.15；I=0%）。
本荟萃分析表明，俯卧位 PCNL 的结石清除率与仰卧位 PCNL 相当。然而，主要在 RCT 研究中，我们观察到仰卧位在手术时间、术后住院时间方面优于俯卧位。
