A Network Meta-Analysis And Clinical Study Of Surgical Treatment Of Congenital Hydronephrosis In Children

Objective: This study used Bayesian mesh meta-analysis to compare Open pyeloplasty(OP),Laparoscopic pyeloplasty(LP),and robot-assisted laparoscopic pyeloplasty(RALP)by collecting data on pyeloplasty in children with congenital hydronephrosis published online pyeloplasty,for the treatment of congenital hydronephrosis in children,from which the most likely surgical modality is selected.Through clinical studies,the efficacy of different surgical methods in the treatment of cong enital hydronephrosis in children was compared,and the results of database analysis and clinical analysis were confirmed by each other,and a more intuitive comparison was made for the treatment of congenital hydronephrosis in children,which provided a t heoretical reference for clinical practice.Methods: The literature on pyeloplasty in infants with congenital pyeloplasty published as of February 2023 was searched from 8 literature databases at home and abroad,and the relevant literature was manually searched in relevant conferences,newspapers and books.The inclusion and exclusion criteria were used to include and exclude the literature,and finally the documents to be analyzed were screened.The four Chinese databases are CNKI,Chinese Biomedical Lite rature Database(CBM),Weipu Database and Wanfang Medical Network Database;English databases are: Web of Science,Clinical trials,The Cochrane Library,Pub Med.Design the factors to be included in the data in each document,including the basic information in the literature and the data to be analyzed,and design a table to record the data to be included and summarize the data of all documents.Literature quality assessment was performed prior to the unified analysis of literature data,and the included literature was assessed for bias risk,using the Ne wcastle-Ottawa Scale(NOS),which was mainly used to evaluate the treatment of cohort studies through three modules(selectivity,comparability and outcomes,respectively)and eight entries.Bayesian mesh meta-analysis using ADDIS1.16.7 software.Firstly,the Node Split node analysis model is used for consistency testing,such as P>0.05,indicating that there is no statistical difference between direct and indirect effects,and the consistency is good,and the collected data are analyzed by network meta-analysis;if P<0.05,the non-consistency model is used.For dichotomous variables,such as surgical success and complications,the results were described using odds ratio(OR)and 95% confidence interval(CI);Continuous variables(e.g.,time to surgery,int raoperative bleeding,and length of hospital stay)were described using mean difference(MD)and 95% CI,and ranking plots of the three surgical modalities were summarized.The convergence of the results is expressed by the Potential Scale Reduced Factor(PSRF)value,when 1 ≤ PRSF ≤ 1.05,it indicates good convergence,if the PSRF value is not in this range,it indicates poor convergence,and it is necessary to increase the iteration parameters,and data analysis is carried out after the PRSF value regress es to the interval.Risk of publication bias was analyzed using Stata 14 software and funnels were plotted.The clinical data of children who were treated in the First Hospital of Lanzhou University from January 2008 to January 2023 and underwent surgery f or congenital hydronephrosis were collected,divided into two groups according to OP and LP,screened out cases that met the criteria according to the inclusion and exclusion criteria,sorted out the clinical data of the included children into Excel tables,and analyzed the collected children’s information using SPSS 25 software,the measurement data were expressed as mean ± standard deviation,and the independent sample t-test was used for the comparison of data between groups.Count data is expressed usin g frequency and percentage,and the chi-square test is used for comparison of different sets of data.By confirming and discussing the results of the two groups of analysis,a more intuitive comparison was made for the treatment of congenital hydronephrosi s in children,which provided a theoretical reference for clinical practice.Results:(1)Reticular meta-analysis of three surgical methods for the treatment of congenital hydronephrosis in children: 8 databases were searched,and a total of 46 articles were included,46 articles with a total of 3432 cases,505 cases of RALP,1463 cases of LP,and 1464 cases of OP.Forty-six studies were cohort studies,of which four were three-armed studies and the rest were two-armed.Twenty-one of the 46 studies performed a consistent model analysis of surgical success from cohort studies,and the network meta-results showed no statistically significant difference between the three different surgical modalities.The consistency model analyzed that the hierarchical ranking p robabilities of the three surgical methods in the surgical success rate were RALP,LP,OP,indicating that RALP was the most likely surgical method with the highest surgical success rate.There were 37 studies that conducted non-consistent model comparison analysis of postoperative complications,and the network meta-results showed that the postoperative complications in the LP group were less than in the OP group,and there was no statistically significant difference between the remaining groups.A total o f 38 studies conducted a consistent model comparison analysis of operation time,and the network meta-results showed that there was no significant statistical difference in operation time between the three surgical methods.The consistency model analyzed t hat the hierarchical ranking probabilities of the three surgical methods in terms of operation time were LP,RALP,OP,indicating that LP was the most likely surgical method with the shortest operation time.Twenty-two studies conducted a consistent model comparison analysis of intraoperative bleeding,and the network meta-results showed that intraoperative bleeding was less than that in the OP group and was statistically significant,and there was no statistically significant difference between the remaini ng groups.The consistency model analyzed that the hierarchical ranking probabilities of the three surgical methods in terms of intraoperative complications were LP,RALP,OP,indicating that LP was the most likely surgical method with the least intraoperative bleeding.Thirty-five non-consistent model comparisons were conducted on length of hospital stay,and the network meta-results showed that the length of hospital stay in the LP group was less than that in the OP group,and the difference was statistic ally significant,and there was no significant statistical difference between the remaining groups.(2)Clinical study of surgical treatment of congenital hydronephrosis in children: A total of 51 children with congenital hydronephrosis who underwent surgery i n the First Hospital of Lanzhou University from January 2008 to January 2023 were collected,including 44 in the OP group and 7 in the LP group.There were no significant differences between 6 cases(13.6%)and 1(14.3%)in the OP group and 1(14.3%)in the LP group.The operation time of the OP group(121.6±32.1)minutes was shorter than that of the LP group(166.4±36.7)minutes,and the difference between the two surgical modalities was statistically different(P<0.05).The intraoperative blood loss volum e(28.6±20.4)ml in the LP group was less than that in the OP group(75.2±17.2)ml,and the difference between the two surgical modalities was statistically significant(P<0.05).The length of hospital stay(10.9±1.8)days in the LP group was less than that in the OP group(14.1±3.9)days,and there was a statistically significant difference between the two surgical modalities(P<0.05).Conclusions:(1)RALP is more likely to be the procedure with the highest success rate of surgery;There are fewer posto perative complications in LP than OP;LP is most likely to be the shortest surgical procedure;Intraoperative bleeding of LP is less than OP,and LP is most likely to be the surgical modality with the least intraoperative bleeding;The LP group had a lower length of hospital stay than the OP group.(2)There was no statistically significant difference in postoperative complications between the two groups.The operation time was longer in the LP group than in the OP group;In terms of intraoperative bleeding a nd postoperative hospital stay,the LP group was lower than that of the OP group.