Supplementary Material for: Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis

<b><i>Objective:</i></b> To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). <b><i>Methods:</i></b> Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. <b><i>Results:</i></b> Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. <b><i>Conclusion:</i></b> Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.

<b><i>研究目的：</i></b> 评估经皮肾镜取石术（percutaneous nephrolithotomy, PCNL）中超声引导通路与透视引导通路的安全性与有效性。<b><i>研究方法：</i></b> 检索Medline（PubMed）、Embase、Ovid、Cochrane及中国生物医学文献数据库，筛选对比超声引导通路与透视引导通路用于PCNL的临床对照试验（clinically controlled trials, CCTs）与随机对照试验（randomized controlled trials, RCTs）。采用RevMan 5.1软件与Stat Manager V4.1软件开展荟萃分析（meta-analysis）。<b><i>研究结果：</i></b> 本研究共纳入5项随机对照试验与9项临床对照试验，总计包含3019例患者。其中1574例（52%）接受超声引导通路，1445例（48%）接受透视引导通路。合并分析结果显示，超声引导通路组的通路建立时长较对照组缩短2.56分钟（加权均数差（weighted mean difference, WMD）=-2.56，95%置信区间（confidence interval, CI）：-4.40~-0.72，p=0.006）。超声引导通路组的结石清除率更高（比值比（odds ratio, OR）=1.26，95%CI：1.02~1.55，p=0.03），手术并发症发生率更低（OR=0.72，95%CI：0.56~0.93，p=0.01），术中失血量更少（WMD=-14.55ml，95%CI：-27.65~-1.46，p=0.03），输血需求率更低（OR=0.39，95%CI：0.24~0.63，p=0.0001）。本研究同时开展了敏感性分析与亚组分析。<b><i>研究结论：</i></b> 除无辐射暴露这一优势外，本荟萃分析结果显示，超声引导通路具备多项显著优势，包括更短的通路建立时长、更少的术中失血量、更低的手术并发症发生率、更低的输血需求率以及更高的结石清除率。鉴于上述显著优势，我们推荐在PCNL术中采用超声引导通路。