Theodoros Spinos, Bhaskar K Somani, Vasileios Tatanis, Andreas Skolarikos, Theodoros Tokas, Thomas Knoll, Angelis Peteinaris, Athanasios Vagionis, Evangelos Liatsikos, Panagiotis Kallidonis
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引用次数: 0
摘要
目的:内窥镜结石病治疗过程中的最佳激光设置仍是一个值得商榷的问题。本系统性综述旨在总结所有现有证据,对不同内窥镜碎石术中高功率(HP)与低功率(LP)激光设置进行比较:根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,对 PubMed、Scopus 和 Cochrane 数据库进行了系统筛选。纳入了所有内镜激光碎石手术方法,包括输尿管镜检查(URS)、逆行肾内手术(RIRS)、经皮肾镜碎石术(PCNL)和经尿道膀胱结石碎石术。小儿患者也包括在内:共有 10 项研究符合纳入标准,并被纳入最终的定性综述。在大多数研究中,HP组的总手术时间(OT)较短。HP组的平均碎石时间明显缩短。LP组的无结石率(SFR)从59.0%到100%不等,HP组从78.9%到100%不等。在六项研究中,LP 组的总并发症发生率较高,在一项研究中,两组的并发症发生率相当,而在一项研究中,HP 组的并发症发生率较高:结论:HP 激光碎石术是一种安全、高效的尿路碎石术、RIRS、PCNL 和膀胱碎石术方法。HP激光碎石术的总手术时间明显更短,而一些研究报告显示,HP组的SFR也更好。对不同结石情况下的 HP 和 LP 激光碎石进行比较的随机对照试验的实施至关重要,这样才能得出更好的结论。
High-power versus low-power laser settings during endoscopic stone disease management: a systematic review from the EAU endourology section.
Purpose: Optimal laser settings during endoscopic stone disease management still represents a debatable issue. The aim of this systematic review is to summarize all existing evidence regarding the comparison of high-power (HP) versus low-power (LP) laser settings during different endoscopic lithotripsy procedures.
Methods: PubMed, Scopus and Cochrane databases were systematically screened, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All endoscopic laser lithotripsy surgical approaches were included, including ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and transurethral lithotripsy for bladder stones. Pediatric patients were also included.
Results: In total, 10 studies met the inclusion criteria and were included in final qualitative synthesis. In most studies total operative time (OT) was shorter for the HP group. Mean fragmentation time was homogenously significantly shorter in the HP group. Stone-free rates (SFR) ranged from 59.0% to 100% for the LP group and from 78.9% to 100% for the HP group. Total complication rates were higher for the LP group in six studies, equivalent between the two groups in one study and higher in the HP group in one study.
Conclusion: HP laser lithotripsy is a safe and efficient approach for URS, RIRS, PCNL and cystolithotripsy. HP laser settings were associated with significantly shorter total operative time, while some studies reported also better SFR in the HP groups. The implementation of more Randomized Controlled Trials comparing HP and LP laser lithotripsy in different stone settings is of outmost importance, so that better conclusions can be drawn.
期刊介绍:
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.