我们旨在对随机试验进行系统评价,以总结无管化经皮肾镜取石术(PCNL)(输尿管支架/导管,无肾造口术)与标准PCNL(肾造口术,有/无输尿管支架/导管)以评估无管状方法是否更好。具有随机效应的平均差的逆方差,95%置信区间(CI)和p值用于连续变量。使用随机效应模型使用Cochran-Mantel-Haenszel方法评估分类变量,并报告为风险比(RR),95%CI和p值。统计显著性设定为p<0.05和95%CI。共纳入26项研究。无内胎组的平均手术时间明显缩短(MD-5.18分钟,95%CI-6.56,-3.80,p<0.00001)。无内胎组的平均术后住院时间也明显缩短(MD-1.10天,95%CI-1.48,-0.71,p<0.00001)。输血的发生率,血管栓塞用于控制出血,术后第一天的疼痛评分,需要术后止痛药的患者数量,发烧,尿路感染,脓毒症,肾周积液,胸膜破裂,医院再入院,和SFR在两组之间没有差异。无内胎组术后尿瘘发生率明显较低(RR0.18,95%CI0.07,0.47,p=0.0005)。本系统评价显示,无管状PCNL可以安全地进行,突出的好处是手术时间和住院时间更短,术后尿瘘发生率较低。
We aimed to perform a systematic
review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic
review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.