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对于大于20毫米的结石,PCNL与两个阶段的RIRS:系统性审查,元分析和试验顺序分析
Beatriz T Constantinou1, Bianca C Benedicto1, Breno C Porto2
1Ninth of July University (UNINOVE), São Paulo, Brazil.
Minerva urology and nephrology
|March 1, 2024
概括
逆行性内手术 (RIRS) 重复多达两次,为大结石提供相当于皮肤结石切除 (PCNL) 的无结石率,潜在的并发症更少,住院时间更短.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 手术创新 在外科创新.
背景情况:
- 穿皮石切除术 (PCNL) 是20毫米以上结石的标准.
- 逆行性内外科手术 (RIRS) 是一种具有较少并发症潜力的替代方案.
研究的目的:
- 为了比较PCNL与分阶段RIRS的疗效和安全性,用于20毫米以上的结石.
- 评估两种手术的无石头率 (SFR) 和并发症概况.
主要方法:
- 在主要数据库 (PubMed,Embase,Scopus,Cochrane,Web of Science) 进行系统的文献搜索.
- 包括比较PCNL和RIRS对20毫米以上结石的研究.
- 主要结果:PCNL的SFR与RIRS (允许RIRS重复一次程序).
- 二次结果:SFR (单一手术),手术时间,住院时间,辅助手术,并发症.
- 进行了子组分析和试验顺序分析.
主要成果:
- 在单次手术后,PCNL的SFR更高.
- 当RIRS重复多达两次时,没有观察到SFR的显著差异.
- 只有26%的患者需要第二次RIRS手术.
- PCNL与更高的并发症发生率 (RR=1.51) 和更长的住院时间 (MD 2.57天) 相关.
- 在PCNL和RIRS之间运行时间没有差异.
结论:
- 两阶段的RIRS相当于PCNL,用于在大型结石中实现无结石状态.
- RIRS可能会提供一种更安全的替代方案,效果与PCNL相比较.
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