Totally Tubeless Versus Standard Percutaneous Nephrolithotomy For Upper Urinary Tract Calculi:A Meta-analysis Of Efficacy

Object:Systematic review of the efficacy of totally tubeless percutaneous nephrolithotomy compared to standard percutaneous nephrolithotomy in the treatment of upper urinary tract calculi.Method:Collecting information of randomized controlled trails and clinical controlled trails comparing totally tubeless PCNL versus standard PCNL by searching Pubmed?The Cochrane Library?Embase?CNKI?CBM?Wan Fang Data.literature were screened according to inclusion and excluding criteria.Data were evaluated using Rev MAN 5.3 for meta-analysisOutcome:11 studies mette inclusion criteria covering 439 patients in the experimental group and 485 patients in the control group.the pooled results showed that the totally tubeless PCNL group was significantly reduced the hospital stay[WMD-2.35 95%CI-3.20,-1.49 P<0.00001 ] ?analgsic requirements[WMD-6.81.95%CI-8.40,-5.22 P<0.00001] and the general complications[OR 0.44,95%CI 0.26,0.74 P=0.002<0.05].there was no statistically significant difference in the operation time[WMD-1.71 95%CI-3.58,0.16 P=0.07 ]?the time reture to normal activity[WMD-6.88 95%CI-14.27,0.50 P=0.07]?transfusion of postoperation[OR 0.69 95%CI 0.35,1.37 P=0.29]?fever[OR 0.76 95%CI 0.38,1.50 P=0.42]?renal week effusion[OR 0.41 95%CI 0.13,1.29 P=0.13]?ancillary procedure[OR 0.92 95%CI 0.42,2.01 P=0.83]?mean hemoglobin drop[WMD-0.10.95%CI-0.22,0.01 P=0.07] and mean creatinine drop[WMD-0.01.95%CI-0.03,0.01 P=0.48] and hematuresis[OR 0.60 95%CI 0.14,2.54 P=0.49].Conclusion:Totally tubeless percutaneous nephrolithotomy for treatment of upper urinary calculi compared with standard percutaneous nephrolithotomy,have advantages in hospitalization time,postoperative analgesic use,the general complications,the difference was statistically significant;at the time of surgery and postoperative recovery to normal activity time,postoperative blood transfusion,postoperative fever,renal week effusion,ancillary procedure and postoperative drop in serum creatinine and drop in hemoglobin,hematuria was not statistically significant,.In mastering the indications,strictly selection of patients,totally tubeless percutaneous nephrolithotomy is worthy of careful promotion.