目的:评估PCNL与逆行肾内手术(RIRS)治疗成人肾结石的效果。
方法:我们对Cochrane图书馆进行了全面搜索,MEDLINE,Embase,另外三个数据库,试验登记处,灰色文献的其他来源,会议将持续到2023年3月23日。我们对出版语言或地位没有任何限制。筛选,数据提取,使用GRADE进行的偏倚风险评估和证据确定性(CoE)评级由两名独立审查员一式两份进行.本联合出版物仅关注本综述的主要结果。
结果:我们纳入了42项符合纳入标准的试验。无结石率:PCNL可改善无结石率(RR1.13,95%CI1.08至1.18;I2=71%;39项研究,4088名参与者;低CoE)。主要并发症:PCNL可能对主要并发症几乎没有影响(RR0.86,95%CI0.59至1.25;I2=15%;34项研究,3649;参与者;中度CoE)与RIRS相比。需要二级干预:PCNL可能会减少对二级干预的需要(RR0.31,95%CI0.17至0.55;I2=61%;21项研究,2005年参与者;低CoE)与RIRS相比。
结论:尽管在大多数研究中存在缺陷,使我们对效果的估计的确定性降低到很低或很低,我们发现PCNL可以提高结石清除率,减少二次干预的需要,同时不影响主要并发症.与RIRS相比,输尿管狭窄率可能相似。我们希望本综述的发现有助于有关肾结石患者管理选择的共同决策。
OBJECTIVE: To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.
METHODS: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk-of-bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co-publication focuses on the primary outcomes of this
review only.
RESULTS: We included 42 trials that met the inclusion criteria. Stone-free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08-1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59-1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17-0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS.
CONCLUSIONS: Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this
review to be helpful for shared decision-making about management choices for individuals with renal stones.