| Objectives:To systematically evaluate the security and effectiveness of one-stage single-channel percutaneous nephrolithotomy combined with flexible ureteroscopes(intervention group)compared with multi-channel percutaneous nephrolithotomy(control group)in the treatment of complex kidney calculi.Methods:To search the literatures about one-stage single-channel percutaneous nephrolithotomy combined with flexible ureteroscopes compared with Multi-channel percutaneous nephrolithotomy published in English and Chinese databases such as PubMed,Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),wan-fang and VIP were retrieved by December 2019.Literature was strictly included and data were extracted according to the criterion of exclusion and inclusion.Finally,it was summarized and evaluated by Stata12.0 software.Results:Literature search results:Three Chinese databases,CNKI,Wan-fang and VIP,were retrieved respectively with kidney calculi,percutaneous nephrolithotomy and ureteroscope as Chinese subject words,and a total of 670 related documents were retrieved.12 articles were selected after deleting duplicate articles,reading titles and s.Searching English databases of PubMed and Cochrane Library with kidney calculi,percutaneous nephrolithotomy and ureteroscope as English mesh words,and a total of 127 related literatures were retrieved,but no standard documents were found with careful reading.After intensive reading of the literatures,one article of non-synchronous was excluded,and 11 articles were included in the literature.Results of included literature:According to the inclusion and exclusion criteria,a total of 11 documents were included,all of studies were Chinese literatures,including 5 randomized controlled trials(RCTs)and 6 clinical controlled trials(CCTs).The RCT was scored according to the Jadad scale,2 articles were 2 points and 3 articles were 3 points,with low quality.The CCT was scored according to the Newcastle Ottawa scale(NOS),in which 2 articles scored 6 and 4 articles scored 7.3.Results of literature inclusion:A total of 11 literatures were included in strict accordance with the inclusion and exclusion criteria,all of which were Chinese literatures,including 5 randomized controlled trials(RCTs)and 6 clinical controlled trials(CCTs).The RCT was scored according to the Jadad scale,of which 2 articles were 2 points and 3 articles were 3 points,both of which were of low quality.The CCT was scored according to the Newcastle-Ottawa Scale(NOS),which included 2 articles with 6 points and 4 articles with 7 points.Meta analysis results:In this article,meta-analysis was performed on six aspects:stone free rate(SFR),complications after operation,operation time,postoperative hemoglobin decline,postoperative hospital stay,and intraoperative blood loss.Comparison of SFR in groups:SFR obtained in intervention group was lower in control group,the difference was not obvious but indicates statistical significance,the heterogeneity was significantly reduced after excluding the two studies of Chen Jiaming(2017)and Hu Yongwen(2018).In terms of design of experiment,the two studies belongs to the RCT,according to the GARDE quality classification of evidence,the evidence level is higher,its instead become the source of the heterogeneity.As a result,the difference between the two groups was not statistically significant before the exclusion of the two studies,while after the exclusion of the two studies,SFR was lower than the control group.It is speculated that the result of strict RCT may be opposite,and the strict RCT may be obtained higher SFR than the control group.(I2=39.5%,P=0.085,before take them out),(I2=0%,P=0.489),(OR=0.659 95%CI[0.456,0.952],P=0.026<0.05,after take them out).Comparison of complications after operation in groups:complications after operation obtained in intervention group was lower in control group,the difference was not obvious but indicates statistical significance(OR=0.528,95%CI[0.317,0.880],P=0.014<0.05).Comparison of operation time in tow groups:there was no statistical significance in the operation time between the intervention group and the control group(SMD=0.316,95%CI[-0.433,1.064],P=0.408>0.05).Comparison of postoperative hemoglobin decline in groups:postoperative hemoglobin decline obtained in intervention group was significantly lower in control group,the difference was obvious and indicates statistical significance(SMD=-0.709,95%CI[-0.876,-0.541],P=0.000<0.05).Comparison of postoperative hospital stay in tow groups:postoperative hospital stay obtained in intervention group was significantly shorter in control group,the difference was obvious and indicates statistical significance,the heterogeneity was significantly reduced after excluding the two studies of Zheng Jianzhong 2016 and Xiang Chenhui 2017,heterogeneity may be caused by different operative levels of the surgeon,different intraoperative and postoperative complications,and also related to the patients themselves(I2=84.3%,P=0,before take them out),(I2=46.0%,P=0.099),(SMD=-0.801,95%CI[-0.982,-0.620],P=0.000<0.05,after take them out).Comparison of intraoperative blood loss in tow groups:intraoperative blood loss obtained in intervention group was significantly less in control group,the difference was obvious and indicates statistical significance,heterogeneity test indicated the heterogeneity was obvious,heterogeneity may be caused by the operative levels of the surgeon,the renal puncture skills(I2=99.0%,P=0),(SMD=-0.1.057,95%CI[-1.377,-0.737],P=0.000<0.05).Conclusions:Compared with multi-channel PCNL,one-stage single-channel PCNL combined with FURL achieve better outcomes,less intraoperative blood,lower postoperative hemoglobin decline,lower complications after operation,and shorter postoperative hospital stay.It is beneficial to the patient’s recovery,but in terms of the operation time,the analysis results are not statistically significant due to various reasons such as different operation levels and inconsistent surgical equipment.In terms of SFR,since the two studies of Hu Yongwen 2018 and Chen Jiaming 2017 belong to the RCT,according to the GARDE quality classification of evidence,these two evidences level are higher,its instead become the source of the heterogeneity.As a result,the difference between the two groups was not statistically significant before the exclusion of the two studies,while after the exclusion of the two studies,SFR was lower than the control group.It is speculated that the result of strict RCT may be opposite,and the strict RCT may be obtained higher SFR than the control group.One-stage single-channel PCNL combined with FURL is safer and more effective in the treatment of complex kidney calculi. |
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