Comparison Of The Effectiveness Of Supine And Prone Percutaneous Nephroscopic Surgery:A Meta-analysis Of Randomized Controlled Trials

Objective: To compare the safety and effectiveness of percutaneous nephrolithotomy(PCNL)in the supine and prone positions of patients with renal or upper ureteral stones.In some special cases,PCNL is more suitable for patients than prone position.Methods: Pubmed,Embase,and Cochrane and China How Net and Wanfang Electronic Journal full-text databases were searched to determine all eligible studies.All included randomized controlled trials(RCTs)were evaluated based on inclusion and exclusion criteria.Two researchers independently screened and evaluated the quality of included studies based on the methods of the Cochrane Handbook and extracted data including author name,publication time,sample inclusion and exclusion criteria,sample size,baseline characteristics of the research subjects,research methods,interventions,outcomes Indicators,including:operation time(min),stageⅠstone removal rate(%),length of hospital stay(d);total complication rate(%);fever,airway resistance before and after placement(mm Hg),RevMan 5.3 Software performs meta analysis.Results: Our meta-analysis included a total of 22 randomized controlled trials with a total of 1967 patients.The baselines are comparable.Meta analysis results showed that the overall calculus rate in the supine group was 82.7% and that in the prone group was 83.9%;there was no significant difference between the two(P =0.28).The operation time in the supine group was significantly shorter than that in the prone group(P <0.00001).There was no statistical difference in hospital stay between the two(P = 0.42).There was no significant difference in the overall complication rate between the supine group and the prone group(P = 0.09),but the postoperative fever rate showed a significant reduction in the fever rate in the supine group(P = 0.02).On the comparison of the breathing cycle,it was found that the baseline levels of airway resistance before the positioning of the two groups of patients were the same,and the airway resistance after the positioning of the two groups of patients had significant statistical differences in the study.The airway resistance of the patient was significantly higher than that in the supine group after positioning(P <0.00001).Conclusion: Compared with prone position PCNL,supine position PCN has less influence on the patient’s respiratory system and a wider range of people,especially in elderly and obese patients with severe heart and lung disease.At the same time,PCNL in this position also has short surgical time,which also offers some potential advantages.For example,it can provide surgeons with the opportunity to perform PCNL and ureteroscopy simultaneously,saving time on the patient’s turn.Postoperative fever was lower.Compared with the prone position PCNL,the supine position PCNL had no difference in the rate of stage Ⅰ lithotripsy,length of hospital stay,and overall complication rate.However,due to the existence of objective reasons such as the difference in the quality of randomized trials and the small sample content,the results of this study still require further verification of homogeneous large sample RCTs.