摘要
目的 系统评价不同体位对经皮肾镜取石手术临床效果的影响。方法 计算机检索PubMed、Web of Science、EBSCO、Cochrane Library、Embase、CNKI、WanFang Data、VIP和CBM数据库,搜集与研究目的相关的随机对照试验(RCT),检索时限均为2014年1月至2024年4月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 18.0软件进行网状Meta分析。结果 共纳入54个RCT,包括5 092例患者,涉及7种体位。最佳概率排序结果显示,体位安置时间方面,分腿俯卧位体位安置时间最短,传统俯卧位体位安置时间最长;通道建立时间方面,斜卧截石位通道建立时间最短,传统俯卧位时间最长;术中出血量方面,仰卧位术中出血量最少,传统俯卧位术中出血量最多;手术时间方面,斜卧截石位的手术时间最短,传统俯卧位的手术时间最长;术后住院时间方面,仰卧位术后住院时间最短,传统俯卧位术后住院时间最长;并发症发生率方面,斜仰卧位作为最佳干预方式时并发症发生率最低,传统俯卧位并发症发生率最高;结石清除率方面,改良弯曲俯卧位结石清除率最高,传统俯卧位结石清除率最低。结论 现有研究表明不同体位对经皮肾镜取石手术临床效果的影响具有差异,斜卧截石位在缩短通道建立时间和手术时间方面可能具有更好的效果;仰卧位在降低术中出血量和缩短术后住院时间上可能更具有优势;分腿俯卧位在缩短体位安置时间、斜仰卧位在降低并发症发生率和改良弯曲俯卧位在提高结石清除率方面效果最好。受纳入研究的数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To systematically review the efficacy of different positions on the clinical outcomes of percutaneous nephrolithotomy(PCNL).Methods The PubMed,Web of Science,EBSCO,Cochrane Library,Embase,CNKI,WanFang Data,VIP,and CBM databases were electronically searched to collect randomized controlled trials(RCTs)related to the objectives from January 2014 to April 2024.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies,a network meta-analysis was conducted using Stata 18.0 software.Results A total of 54 RCTs involving 5092 patients and 7 different positions were included.The results of the best probability ranking showed that for positioning time,the split-leg prone position required the shortest time,while the traditional prone position required the longest.For access establishment time,the recumbent lithotomy position had the shortest duration,and the traditional prone position the longest.Intraoperative blood loss was lowest in the supine position and highest in the traditional prone position.Surgical duration was shortest for the recumbent lithotomy position and longest for the traditional prone position.Postoperative hospital stay was shortest for the supine position and longest for the traditional prone position.Complication rates were lowest for the oblique supine position and highest for the traditional prone position.Stone clearance rates were highest for the modified curved prone position and lowest for the traditional prone position.Conclusion Current evidence shows that different body positions have different clinical effects on percutaneous nephrolithotomy.The recumbent lithotomy position may optimize access establishment and surgical duration,while the supine position offers advantages in reducing intraoperative blood loss and shortening postoperative hospitalization.The split-leg prone position minimizes positioning time,the oblique supine position lowers complication rates,and the modified curved prone position maximizes stone clearance.Due to the limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusion.
作者
王晶
高梦昕
陈雨钦
陈媛
刘春香
张敏
刘永达
孙红玲
WANG Jing;GAO Mengxin;CHEN Yuqin;CHEN Yuan;LIU Chunxiang;ZHANG Min;LIU Yongda;SUN Hongling(School of Nursing,Guangzhou Medical University,Guangzhou 510000,P.R.China;Department of Nursing,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,P.R.China;Haiyin Operating Room,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,P.R.China;Department of Urology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,P.R.China)
出处
《中国循证医学杂志》
北大核心
2025年第11期1301-1310,共10页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:82370766)。
关键词
手术体位
经皮肾镜取石术
网状Meta分析
随机对照试验
Operative position
Percutaneous nephrolithotomy
Network meta-analysis
Randomized controlled trials
