Nephrostomy Tube-Free versus Nephrostomy Tube for Renal Drainage after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis
Nephrostomy Tube-Free versus Nephrostomy Tube for Renal Drainage after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis
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DOI：
10.1159/000332151
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发表时间：
2012-03
影响因子：
1.6
通讯作者：
P. Shen;Yong Liu;Jia Wang
中科院分区：
文献类型：
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作者：
P. Shen;Yong Liu;Jia Wang
背景：历史上，经皮肾镜取石术（PNL）后经皮肾造口引流一直被认为是标准的治疗方法。然而，最近越来越多的中心开始实施无管（插入JJ输尿管支架）或完全无管（无内部或外部引流）的PNL，结果数据令人印象深刻。目的：比较无管肾造口术（NT-free）与标准肾造口术（PNL）的临床疗效和安全性。材料和方法：我们检索PubMed（1966年至2011年4月）、Embase（1966年至2011年4月）和Cochrane图书馆，没有语言限制。所有比较无nt PNL（使用双j型支架）与标准PNL的随机对照试验均纳入本综述。采用Cochrane Collaboration的RevMan5.0.2软件进行统计分析。结果：纳入9项研究，547例患者。患者分为4组：无nt组、小管组（8 - 9fr）、中管组（16 - 18fr）、大管组（20 - 24fr）。meta分析显示：(1)无nt组术后第1天疼痛的住院时间(h)和视觉模拟量表评分与小管组比较差异无统计学意义，但与中、大管组比较差异有统计学意义；(2)穿刺部位尿漏，无nt组与小、中管组无显著差异；(3)无nt组与3管组在输血、发热、感染、手术时间等方面均无显著差异。结论：无nt管与小管的临床疗效和安全性在各项指标上相似。与中、大管相比，无nt PNL可减少住院时间和术后镇痛需求，且不增加其他并发症。
Background: Historically, percutaneous nephrostomy drainage following percutaneous nephrolithotomy (PNL) has been considered the standard of care. More recently, however, an increasing number of centers are performing tubeless (with insertion of JJ ureteric stent) or totally tubeless (with no internal or external drainage) PNL with impressive outcome data. Objective: This systematic review is to compare the clinical therapeutic efficacy and safety of nephrostomy tube-free (NT-free) and standard PNL. Materials and Methods: We searched PubMed (1966 to April 2011), Embase (1966 to April 2011), and the Cochrane Library without language restriction. All randomized controlled trials that compared NT-free PNL (using a double-J stent) with standard PNL were enrolled in this review. The Cochrane Collaboration’s RevMan5.0.2 software was used for statistical analysis. Results: Nine studies involving 547 patients were included. Patients were divided into 4 groups: NT-free group, small tube group (8–9 Fr), middle tube group (16–18 Fr), and large tube group (20–24 Fr). Meta-analysis showed that: (1) with regard to hospital stay (h) and visual analog scale scores for postoperative pain on day 1, there was no significant difference between the NT-free group and the small tube group, but there were differences between the NT-free group versus the middle and large tube groups; (2) for puncture site urinary leakage, no significant difference was found between the NT-free group and the small and middle tube groups; (3) no significant difference was found with regard to transfusion, fever or infection, operative time between the NT-free group and the 3 tube groups. Conclusions: The clinical efficacy and safety of NT-free and small tube are similar in all measurements. Compared with the middle and large tubes, NT-free PNL could reduce hospital stay and postoperative analgesia requirement without increasing other complications.