摘要
背景近年来,随着输尿管软镜技术的发展,输尿管软镜技术在泌尿外科的应用已越来越广泛,但输尿管软镜术前是否需要常规留置输尿管支架管,目前尚存在较大争议。目的系统评价输尿管软镜术前是否需要常规留置输尿管支架管。方法计算机检索Cochrane Library、PubMed、EMBase、维普网(VIP)、中国生物医学文献数据库(CBM)、中国知网(CNKI)和万方数据知识服务平台,同时辅以其他检索,收集关于输尿管软镜术前常规留置输尿管支架管(治疗组)和未留置输尿管支架管(对照组)的随机对照试验(RCT)和病例对照研究,检索时限均为2000-2017年。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入文献的方法学质量,采用RevMan 5.3软件进行Meta分析。结果最终纳入4篇RCT、6篇病例对照研究,共1 827例患者。Meta分析结果显示,治疗组手术时间短于对照组〔均数差(MD)=-1.45,95%CI(-1.93,-0.96),P<0.000 01〕,手术成功率和一次性软镜鞘通道放置成功率均高于对照组〔OR=1.55,95%CI(1.14,2.09),P=0.005;OR=14.77,95%CI(5.26,41.43),P<0.000 01〕。两组住院时间和并发症发生率比较,差异均无统计学意义〔MD=1.22,95%CI(-0.39,2.83),P=0.14;OR=1.38,95%CI(0.93,2.04),P=0.11〕。结论与输尿管软镜术前未留置输尿管支架管相比,输尿管软镜术前常规留置输尿管支架管虽然不能缩短住院时间及降低术后并发症发生率,但可以在一定程度上增加手术成功率和一次性软镜鞘通道放置成功率,并缩短手术时间。
Background In recent years,with the development of flexible ureteroscopy technology,flexible ureteroscopy technology in urology has a more widespread application.However,whether ureteral stenting is routinely placed in patients before flexible ureteroscopy is still controversial.Objective To systematically review whether conventional ureteral stenting was required before flexible ureteroscopy.Methods We searched the Cochrane Library,PubMed,EMBase,VIP,CBM,CNKI and Wanfang Data and the other sources from January 2000 to December 2017.All the randomized controlled trials(RCTs) and case-control studies reporting on patients who received flexible ureteroscopy with or without previous ureteral stenting were included.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the included studies.Then RevMan 5.3 software was used for metaanalysis.Results Four RCTs and six case-control studies involving 1 827 patients were finally included.The results of metaanalyses showed that compared with the group without ureteral stenting before flexible ureteroscopy,group with ureteral stenting before flexible ureteroscopy could increase the success rate of operation〔OR=1.55,95%CI(1.14,2.09),P=0.005〕 and the success rate of one-off placement of ureteral access sheath〔OR=14.77,95%CI(5.26,41.43),P<0.000 01〕 and decrease the time of operation[MD=-1.45,95%CI=(-1.93,-0.96),P<0.000 01].There was no significant difference in the time of hospitalization[MD=1.22,95%CI(-0.39,2.83),P=0.14] and occurrence rate of postoperative complications [OR=1.38,95%CI(0.93,2.04),P=0.11].Conclusion Ureteral stenting before flexible ureteroscopy could not decrease the time of hospitalization and the postoperative complications rate,but it could increase the success rate of operation and the success rate of one-off placement of ureteral access sheath and decrease the time of operation in a certain extent.
作者
刘俊波
姜果
陈小彬
周文浩
于睿超
邬韬
LIU Junbo;JIANG Guo;CHEN Xiaobin;ZHOU Wenhao;YU Ruichao;WU Tao(Department of Urology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Pathophysiology and Molecular Pharmacology,Joslin Diabetes Center,Harvard Medical School,Boston 02446,USA)
出处
《中国全科医学》
CAS
北大核心
2020年第5期573-579,共7页
Chinese General Practice
