<b>Comparative outcomes of image-guided percutaneous catheterisation versus direct visualisation catheterisation for peritoneal dialysis: a meta-analysis</b>

This meta-analysis was conducted in accordance with the Preferred Reporting Project for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines [29, 30]. The databases of PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for articles up to July 16, 2024. The search methodology followed the PICOS principle and employed a combination of MeSH terms and unrestricted textual phrases. The search method utilised involved the amalgamation of the terms "Peritoneal Dialysis," "catheter," "direct visualisation catheterisation" and "image-guided percutaneous catheterisation". Inclusion criteria: (1) Patients with ESRD who underwent PD catheter placement; (2) Interventional group: patients received IGPC, comprising percutaneous puncture techniques utilising X-ray fluoroscopy or ultrasound guidance; (3) Control group: patients received DVC, comprising conventional open surgery or catheter placement techniques performed under laparoscopy; (4) At least one of the following outcomes was reported: peritonitis, tunnel infection, exit-site infection, catheter dysfunction, bleeding, catheter leakage, hernia, catheter removal, and one-year PD catheter survival. (5) Study design: RCT, prospective study, or retrospective study. Exclusion criteria: (1) Other types of articles, including conferences, abstracts, yearbooks, case reports, journals, letters, reviews, meta-analyses, editorials, pharmaceutical interventions, animal studies, and protocols; (2) Not relevant; (3) Duplicate patient cohort; (4) Inability to extract data for meta-analysis. EndNote (Version 20; Clarification Analysis) was utilised to oversee the selection of retrieved studies, including the elimination of duplicates. All study results were evaluated utilising Review Manager 5.3 (Cochrane Collaboration, Oxford, UK). The odds ratio (OR) accompanied by a 95% confidence interval (CI) was employed to compare the binary variables. Cochrane Q p-values and I2statistics were employed to assess heterogeneity in all meta-analyses. The potential for publication bias was evaluated through a visual examination of the funnel plot. Sensitivity analyses were performed by sequentially excluding each study to assess the impact of individual studies on the aggregated results and to evaluate the reliability of the findings. The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.本项Meta分析严格遵循《系统评价与Meta分析优先报告条目（PRISMA）2020版》[29,30]规范开展。研究系统检索了PubMed、Embase、Web of Science及Cochrane图书馆数据库，检索时限截至2024年7月16日。检索策略遵循PICOS原则，结合医学主题词（MeSH）与自由文本短语构建检索式，本次检索整合了“腹膜透析（Peritoneal Dialysis）”“导管（catheter）”“直视下导管置入术（direct visualisation catheterisation）”及“影像引导经皮导管置入术（image-guided percutaneous catheterisation）”相关检索词。 纳入标准如下：（1）接受腹膜透析导管置入术的终末期肾病（End-Stage Renal Disease, ESRD）患者；（2）干预组：接受影像引导经皮导管置入术（IGPC）的患者，即采用X线透视或超声引导的经皮穿刺置管技术；（3）对照组：接受直视下导管置入术（DVC）的患者，包括传统开放手术或腹腔镜下导管置入技术；（4）至少报告以下结局指标之一：腹膜炎、隧道感染、出口部位感染、导管功能障碍、出血、导管渗漏、疝、导管拔除及1年腹膜透析导管存活率；（5）研究设计类型为随机对照试验（Randomized Controlled Trial, RCT）、前瞻性研究或回顾性研究。 排除标准如下：（1）其他类型文献，包括会议论文、摘要、年鉴、病例报告、期刊信件、综述、Meta分析、社论、药物干预类研究、动物实验及研究方案；（2）与研究主题不相关的文献；（3）患者队列重复的文献；（4）无法提取用于Meta分析所需数据的文献。 研究采用EndNote 20（科睿唯安）对检索得到的文献进行管理，剔除重复文献。所有研究结果均通过Review Manager 5.3（英国牛津Cochrane协作组）进行评价。对于二分类变量，采用比值比（odds ratio, OR）及其95%置信区间（confidence interval, CI）进行效应量合并。采用Cochrane Q检验P值与I²统计量评估所有Meta分析的异质性。通过漏斗图可视化评估发表偏倚风险。依次排除单项研究开展敏感性分析，以明确单篇研究对合并效应量的影响，并验证研究结果的可靠性。本研究未存在任何可能被视为潜在利益冲突的商业或财务关联。