无侧腹改良仰卧位与俯卧位在小儿肾镜碎石中的应用：一项最新的系统综述和荟萃分析。

IF 1.7 3区医学 Q3 UROLOGY & NEPHROLOGY

BMC Urology Pub Date : 2024-11-30 DOI:10.1186/s12894-024-01660-z

Breno C Porto, Roberto N Santana, Ingrid M S Duarte, Carlo C Passerotti, Rodrigo A S Sardenberg, Ronaldo S Maia, Jose P Otoch, Jose A S da Cruz

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引用次数: 0

摘要

导读：经皮肾镜取石术（PCNL）是治疗大于20mm肾结石的首选方法，目前的研究主要集中在比较俯卧位和仰卧位的结果，以确定最佳的手术位。因此，本研究的目的是比较俯卧位和仰卧位在小儿PCNL中的疗效，为指导临床决策的这一关键方面提供清晰的信息。方法：对PubMed、Embase、Scopus、Cochrane、Web of Science、谷歌Scholar等数据库进行系统综述。我们纳入了比较儿科患者俯卧位和仰卧位PCNL的研究。我们的主要终点是无结石率（SFR）。次要结局包括手术时间、住院时间和总并发症发生率。使用Review Manager 5.4进行统计分析。结果：共检索到8篇文献，俯卧位组269例，仰卧位组223例。患者平均年龄7.92岁。我们的研究结果显示，两个位置的SFR无统计学差异(OR 0.67；Ci95 0.38, 1.18；p = 0.17；i2 = 0%)。此外，我们注意到仰卧位组的手术时间显著减少(MD 13.75；Ci95 4.35, 23.15；p = 0.004；i2 = 84%)。同时，仰卧位组术后住院时间较低(MD = 0.61；Ci95 0.34, 0.88；p 2 = 21%)。两组总并发症发生率无差异(OR 1.47；Ci95 0.88, 2.47；p = 0.15；i2 = 0%)。结论：我们的荟萃分析表明，就SFR而言，俯卧位PCNL与仰卧位PCNL相当。然而，主要是在RCT研究中，我们可以观察到与俯卧位相比，仰卧位在更短的手术时间和更短的术后住院时间方面的好处。

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Flank-free modified supine vs. prone position for pediatric nephrolithotripsy: an updated systematic review and meta-analysis.

Introduction: 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.

Methods: 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.

Results: 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; I² = 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; I² = 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; I² = 21%). No difference was observed regarding the total complication rate (OR 1.47; CI95 0.88, 2.47; p = 0.15; I² = 0%).

Conclusion: 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.

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来源期刊

BMC Urology UROLOGY & NEPHROLOGY-

CiteScore

3.20

自引率

0.00%

发文量

177

审稿时长

>12 weeks

期刊介绍： BMC Urology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of urological disorders, as well as related molecular genetics, pathophysiology, and epidemiology. The journal considers manuscripts in the following broad subject-specific sections of urology: Endourology and technology Epidemiology and health outcomes Pediatric urology Pre-clinical and basic research Reconstructive urology Sexual function and fertility Urological imaging Urological oncology Voiding dysfunction Case reports.