超音波導引與x光透視導引經皮穿腎造廔取石術之比較
楊宇祥1、溫玉清2、陳冠州3、陳杰峰4、陳建綸5
1林口長庚紀念醫院 教學部；2萬芳醫院 泌尿部；3雙和醫院 泌尿部；考科藍台灣,萬芳實證中心、外科部4；林口長庚紀醫院 泌尿部
Ultrasound‐guided versus fluoroscopy‐guided percutaneous nephrolithotomy: a systematic review and meta‐analysis of randomized controlled trials
Yu‐Hsiang Yang 1, Yu‐Ching Wen2, Kuan‐Chou Chen, Chiehfeng Chen, Chien-Lun Chen
Department of Medical education, Linkou Chang Gung Memorial Hospital, Taoyuan District, Taoyuan, Taiwan 1 Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 2, Department of Urology, Shuang-Ho Hospital 3 Cochrane Taiwan, Taipei Medical University 4 Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan5
Purpose: To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL).
Materials and Methods: A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay.
Results: Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67–1.35; p = 0.79] irrespective of the patient’s position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36–0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes.
Conclusions: UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG- PCNL could be performed with patients in the supine position without compromising its efficacy.