A Meta-analysis Of The Efficacy And Safety Of Microchannel And Standard Channel Percutaneous Nephrolithotomy In The Treatment Of Kidney Stones

ObjectiveWe aimed to compare the efficacy and safety of microchannel percutaneous nephrolithotomy with standard channel percutaneous nephrolithotomy in the treatment of kidney stones,and to provide a theoretical basis for the clinical choice of a more appropriate procedure.Methods:The Cochrane Library,PubMed,EMBASE,CNKI,VIP,WANFANG,and CBM databases were searched through computer networks using a search strategy of subject terms combined with free words based on a full search,to retrieve information about microchannel percutaneous nephrolithotomy（MPCNL）Randomized controlled trials（RCTs）of microchannel percutaneous nephrolithotomy（MPCNL）versus standard channel percutaneous nephrolithotomy for the treatment of kidney stones（SPCNL）were searched from January 2010 to December2021.2 investigators selected and evaluated the quality of the screened literature according to the inclusion and exclusion criteria,determined the final inclusion and quality,extracted their basic information and trial data in A meta-analysis of the efficacy and safety of MPCNL versus SPCNL in the treatment of kidney stones was performed with the aid of Revman5.4 statistical software。Results:The study ultimately included 16 publications,with a total of 2,294 procedures in the MPCNL group and 2,264 in the SPCNL group.Some of the literature classified the types of kidney stones separately,and this trial divided them into an undifferentiated stone type group,a simple pelvic stone group,a multiple calyx stone group and a deerstalker-like stone group.The results showed that: i)MPCNL had a higher SFR for multi-malar calyx stones [OR=2.39,95% CI（1.40,4.08）,P=0.001],undifferentiated stone type stones SFR [OR=0.99,95% CI(0.97,1.02P=0.61] and simple pelvic stones SFR [OR= 0.61,95% CI（0.34,1.10）,P=0.10],and deerstalker-like stone SFR [OR=0.82,95% CI（0.46,1.46）,P=0.50] were not statistically different;（ii）compared with SPCNL for kidney stones,MPCNL had a statistically significant longer operative time and simple pelvic stones [MD=2.39 95% CI（9.40,16.36）,P<0.00001],deerstalker-like stones [MD=13.38,95% CI（7.94,18.83）,P<0.00001] and multiple calcium-like stones [MD=9.80,95% CI（7.04,12.56）,P< 0.00001];MPCNL for renal stones had a shorter hospital shorter [MD=-0.64,95% CI（-1.07,-0.20）,P=0.04],shorter postoperative fistula retention [MD=-0.33,95% CI（-0.64,-0.02）,P= 0.04],lower postoperative VAS scores [MD=-0.97,95% CI（-1.59,-0.35）,P= 0.002],greater intraoperative perfusion volume [MD=6.54,95% CI（0.42,12.65）,P= 0.04],less intraoperative bleeding [MD=-24.80,95% CI（-47.58,-2.03）,P= 0.03],and lower postoperative HB decline [MD=-0.47,95% CI（-0.62,-0.31）,P< 0.00001],lower probability of intraoperative haemorrhage [OR=0.59,95% CI（0.38,0.92）,P=0.02],lower probability of postoperative blood transfusion [OR=0.42,95% CI（0.25,0.70）P=0.0008];probability of postoperative fever [OR=1.09,95% CI（0.88,1.36）,P=0.44],the probability of sepsis [OR=1.46,95% CI（0.67,3.22）,P=0.34],and the overall probability of complications [OR=0.85,95% CI（0.60,1.22）,P=0.38] were not statistically significant.Conclusions:Both MPCNL and SPCNL are safe and effective surgical methods for the treatment of kidney stones.SPCNL has higher stone-clearing efficiency.MPCNL has higher SFR for multiple calyceal stones,lower intraoperative blood loss and blood transfusion rate,higher comfort,and faster postoperative recovery.