Efficacy Of Minimally Invasive Percutaneous Nephrolithotomy With Holmium Laser And Pneumatic Ballistic For Renal Calculi:a Meta-analysis

Objective:To compare the therapeutic efficacy and safety of holmium laser lithotripsy and pneumatic lithotripsy for renal calculi with minimally invasive percutaneous nephrolithotomy. To access the efficacy and safety of holmium laser treatment of renal calculi and provide the evidence for the clinical treatment. For patients in the operation of equipment selection provides evidence-based evidence.MethodsElectronic searches of Pubmed, Cochrane library, SpringerLink, Embase, CNKI, VIP database, Wan Fang database to collect randomized study of holmium laser lithotripsy and pneumatic lithotripsy for renal calculi. Lives are set to retrieve from building a database to October2013. All the literature data extracted independently by two investigators, and recommended the use of the Cochrane Collaboration risk of bias assessment tool to evaluate the test. Meta analysis was performed with RevMan5.0software. Outcome measures included:gravel operation time, I drained the rate of healing stones, Ⅱ stone clearance rate of treatment, clinical complications, blood loss, postoperative hospital stay, stone free time.Result:Documents in accordance with strict inclusion criteria, and ultimately into the randomized controlled clinical studies a total of six documents, included a total of810cases of patients with holmium laser lithotripsy group of407cases, pneumatic lithotripsy group of403cases. Meta-analysis of the results showed:(1) Comparison of crushed stone operation time:After statistical analysis software by RevMan5.0have TotalWMD=-13.79,95%CI(-18.06,-9.51), Z=6.32, P=<0.00001, differences between the two groups in terms of operation time was statistically significant, holmium laser lithotripsy group operation time is shorter than the pneumatic lithotripsy group.(2) Compare stone clearance rate of Phase Ⅰ treatment: Through the statistical analysis of RevMan5.0software TotalWMD=-13.79,95%CI(-18.06,-9.51),Z=6.32, P=<0.00001, I treat stone clearance rate of the two groups was statistically significant, compared with holmium laser lithotripsy phase Ⅰ treatment lithotripsy stone clearance rate.(3) Compare stone clearance rate of Phase Ⅱ treatment:Through the statistical analysis of RevMan5.0software RR=1.11,95%CI(0.98,1.26), Z=1.70, P=0.09, two groups of treatment Ⅱ stone clearance rate was statistically significant, compared with holmium laser lithotripsy phase Ⅱ lithotripsy treatment of calculi drain rate.(4) Comparison of the incidence of clinical complications:After RevMan5.0statistical analysis software was RR=-0.41,95%CI (0.22,0.73), Z=3.00, P=0.003, two groups in the incidence of clinical complications was statistically significant, holmium laser lithotripsy the incidence of clinical complications set lower than pneumatic lithotripsy group.(5) Compare the amount of blood loss:After RevMan5.0statistical analysis software combined data obtained TotalWMD=-24.41,95%CI (-26.2,-22.55), Z=25.72, P <0.00001, two aspects of blood loss the difference was statistically significant, holmium laser lithotripsy group of bleeding less han pneumatic lithotripsy group.(6) Comparison of postoperative hospital stay: After RevMan5.0statistical analysis software was TotalWMD=-2.14,95%CI(-2.64,-1.64), Z=8.40, P<0.00001, postoperative hospital stay between the two groups was statistically significance, holmium laser lithotripsy group shorter than pneumatic lithotripsy group.(7) Compare stone clearance time:After RevMan5.0statistical analysis software was TotalWMD=-11.00,95%CI-(12.28,-9.72), Z=16.85, P<0.00001two stones drained time difference was statistically significant, holmium laser lithotripsy group drained shorter than pneumatic lithotripsy group.Coclcusions:Through the Meta analysis showed that two kinds of lithotripsy in the treatment of renal calculi with percutaneous nephrolithotomy compared to have the following characteristics:1、Holmium laser lithotripsy time is shorter than pneumatic lithotripsy.2、Holmium laser lithotripsy have high stone clearance rate in treatment I and II.3、Holmium laser lithotripsy of stone clearance time is shorter than pneumatic lithotripsy group.4、Holmium laser lithotripsy compared pneumatic lithotripsy with less blood loss.5、The incidence of clinical complications of holmium laser lithotripsy lower than pneumatic lithotripsy group.6、Holmium laser lithotripsy group shorter than pneumatic lithotripsy group in the postoperative hospital stay.