| Background:Urinary tract calculi is incidence rise along with the social development,Our country have a high incidence of calculi.Percutaneous nephrostolithotomy has become the first choice for the upper ureteral calculi and renal calculi.And placed a nephrostomy tube and a nephrostomy tube was a routine operation steps in traditionally.But the tube make such as postoperative pain,extend the length of hospital stay,increase the risk of infection,ureteral stents removed again,and so on questions get more and more attention from the urologists.To solve the problem,Tubeless PCNL bean brought up;But because at present no tube PCNL is not recognized,Especially in our country is more difficult to promotion because of the tense doctor-patient relationship.Purpose:This study proposed based on the Meta analysis of tubeless percutaneous nephrolithotomy versus standard PCNL.in order to evaluate the efficacy and safety of tubeless PCNL and to guide clinical practice.Method:Reference to The Cochrane handbook for strategy formulation,we searching for the study about tubeless PCNL and standard PCNL from the database such as PubMed,controlled clinical trials database(CENTRAL)and so on,time from 2006 to 2016.Collected using RevMan5.3 software for Meta analysis.Result:There are 13 literatures including experimental group 602 cases,control group 590 cases;Length of hospital stay,there are 10 studies analyzed the length of hospital stay,the result shows that the tubeless PCNL than the standard PCNL shorten hospitalization time of 1.45 days on average,95% CI 1.45 [1.91,0.99];Z = 6.22(P < 6.22).10 paper analyses the operating time,the experimental group is on average than control group shorten the operation time of 0.3 min.[0.44,95% CI 0.30 0.16],Z = 4.29(P < 0.0001).there are 7 studies analyzed the stone clearance,95% CI 1.07 [0.69,1.66],Z = 0.30(P = 0.76)Calculi clearance rate between the two groups showed no statistically significant difference.Hemoglobin decreased quantity: 5 articles were reported,95% CI 0.02 [0.22,0.17],Z = 0.24(P = 0.81)showed that between the two groups there was no significant difference in the amount of hemoglobin decreased.9 paper made statistics on postoperative blood transfusion,95% CI 0.69 [0.44,1.08],Z = 1.62(P = 0.10)showed the two groups has no statistically significant differences.There are 5 studies analyzed Postoperative pain VAS score,95% CI 2.67(4.38,0.97)showed that the experimental group than the control group to reduce the average was 2.63;Z = 3.07(P = 0.002)difference was statistically significant.5 paper analyses the postoperative analgesia drug requirements,Meta-analysis research data shows that 95% CI for 0.97(1.42,0.52),the experimental group is significantly lower than the control group use of analgesic drugs,Z = 4.21(P < 0.0001).Postoperative urinary extravasation(Z = 0.48,P = 0.48)and postoperative fever(Z = 1.96,P = 1.96)no statistically significant difference between the two groups.There are 7 studies analyzed the time of return to normal activities,95% CI 1.36 [2.31,0.41],Z = 2.81(P = 0.005)showed that tubeless PCNL group can make the patients earlier return to normal activities.Conclusion:The patients that screening according to the standard perform tubeless PCNL compared with the traditional PCNL has no obvious difference in calculi clearance rate?surgical blood loss?postoperative urinary extravasation? postoperative fever;and the hospitalization and surgery time is shortened,tubeless PCNL could effectively reduce reduce pain,can be applied as a routine surgical technique. |
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