经皮肾镜取石术分期治疗结石性脓肾临床效果的Meta分析  

Stage-by-stage clinical outcomes of percutaneous nephrolithotomy for calculous pyonephrosis:a Meta-analysis

作　　者：杨斌[1] 耿尔康 万川平 牛愿坚 李玉志 刘建和[1] YANG Bin;GENG Erkang;WAN Chuanping;NIU Yuanjian;LI Yuzhi;LIU Jianhe(Department of Urology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650106,China)

机构地区：[1]昆明医科大学第二附属医院泌尿外科,云南昆明650106

出　　处：《现代泌尿外科杂志》2024年第1期29-36,共8页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.82060137)。

摘　　要：目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国知网、万方、维普数据库,于2012年1月—2022年10月发表的有关于结石性脓肾研究的文章,并根据纳入和排除标准选择文献。在检索数据并评价文献质量后,采用Review Manager software(RevMan 5.4.3,Cochrane协作网,Oxford,UK)进行Meta分析。结果本文从105项研究中选择了11项共688例患者。其中347例接受Ⅰ期PCNL治疗,341例患者接受Ⅰ期PCN及Ⅱ期PCNL治疗(以下简称Ⅱ期PCNL)。Meta分析结果显示:Ⅰ期PCNL和Ⅱ期PCNL在结石清除率(P=0.95)、手术时间(P=0.48)、术后感染性休克(P=0.36)、肾周积液感染(P=0.27)方面差异无统计学意义;Ⅰ期和Ⅱ期PCNL在术后发热(P=0.03)、留置肾造瘘管时间(P<0.01)、住院费用(P<0.01)、住院时间(P<0.01)、术后住院时间(P=0.02)方面差异有统计学意义。对于结石性脓肾患者的治疗,以上2种方案在结石清除率、手术时间、术后发生肾周积液感染及感染性休克的发生方面类似。虽然Ⅰ期PCNL术后发热的患者更多,但是住院费用更低,留置肾造瘘管时间、总住院时间、术后住院时间更短。结论Ⅰ期PCNL治疗肾及输尿管上段结石合并脓肾是经济、安全、有效的,在临床实践中具备一定的推广价值。Objective To identify the best surgical treatment for patients with calculous pyonephrosis by evaluating the clinical effectiveness of percutaneous nephrolithotripsy(PCNL)in stageⅠ,percutaneous nephrostomy(PCN)in stageⅠ,and percutaneous nephrolithotripsy in stageⅡ.Methods For publications published between Jan.2012 and Oct.2022,we thoroughly examined the databases of PubMed,Cochrane Library,Web of Science,EMBASE,CNKI,Wanfang,and VIP.We then chosed the literature based on the inclusion and exclusion criteria.After data were retrieved and literature quality was assessed,Review Manager software(RevMan 5.4.3,Cochrane Collaboration,Oxford,UK)was utilized to Meta-analysis.Results Out of 688 participants across 105 researches,we chosed 11 trials.Among them,341 patients received both stageⅠPCN and stageⅡPCNL(hereinafter referred to as phaseⅡPCNL),while 347 patients received stageⅠPCNL.According to the results of the Meta-analysis,there was no discernible difference between stageⅠPCNL and stageⅡPCNL in terms of stone clearance rate(P=0.95),operation duration(P=0.48),postoperative septic shock(P=0.36),or perirenal effusion infection(P=0.27).There were significant differences between stageⅠPCNL and stageⅡPCNL in fever(P=0.03),indwelling nephrostomy tube time(P=0.01),hospitalization costs(P=0.01),hospitalization time(P=0.01),and postoperative hospitalization time(P=0.02).The following two regimens were comparable in terms of stone clearance rate,operating time,postoperative perirenal effusion infection,and septic shock for patients with calculous pyonephrosis.Despite the fact that there were more patients who developed fever after stageⅠPCNL,hospitalization costs were lower,indwelling nephrostomy tube time,overall hospitalization time,and postoperative hospitalization time were all reduced.ConclusionⅠPCNL was affordable,safe,and successful for treating renal and upper ureteral calculi with pyonephrosis,and it had some promotional value in clinical practice.

关 键 词：泌尿系结石 结石性脓肾 经皮肾镜取石术 经皮肾穿刺造瘘术 荟萃分析 Ⅰ期手术 分期手术 

分 类 号：R692.4[医药卫生—泌尿科学]