术前预置D-J管对输尿管镜碎石术效果影响的荟萃分析

A Meta-analysis of the effect of presetting D-J stent on ureteroscopic lithotripsy

摘要:

目的：采用Meta分析的方法系统评价输尿管镜碎石术（ureteroscopic lithotripsy，URL）术前预置D-J管的安全性及有效性。方法：检索PubMed、Embase、Cochrane Library、维普、万方、中国知网数据库，搜集对比URL术前放置与未放置D-J管效果的随机对照试验（randomized controlled trial，RCT）或对照试验，检索时限为建库至2017年6月，对纳入文献进行质量评价。采用Revman5.2软件进行Meta分析，Stata12.0软件对纳入文献进行敏感性分析和发表偏倚检测。结果：最终纳入14篇研究共12 440例患者。Meta分析结果显示术前预置D-J管（intentional preoperative stent，IPS）组术后无石率（stone-free rate，SFR）较术前未放置D-J管（not preoperative stent，NPS）组高（RR=1.08，95%CI=1.02~1.14，P=0.007），对于肾及输尿管近端结石术后的SFR，IPS组较NPS组高（R=1.46，95%CI=1.05~2.03，P=0.02），而对于输尿管远端结石术后的SFR，IPS组与NPS组间差异无统计学意义（RR=1.14，95%CI=0.92~1.42，P=0.24）。IPS组与NPS组在手术时间（SMD=-0.21，95%CI=-0.73~0.32，P=0.44）与围术期并发症（RR=0.78，95%CI=0.52~1.18，P=0.25）方面差异同样无统计学意义。结论：URL术前留置D-J管可以增加术后无石率，特别对于肾及输尿管近端结石患者。

Abstract:

Objective：To evaluate the safety and efficacy of preoperative D-J stent placement in ureteroscopic lithotripsy（URL） by Meta-analysis. Methods：PubMed，Embase，Cochrane Library，VIP，Wanfang and CNKI database were used to collect the randomized controlled trial（RCT） or controlled trials of the effect of preoperative placement and not placement of D-J stent. The data were up－dated to June 2017. Quality of the literature was evaluated. Meta-analysis was performed using Revman 5.2. Sensitivity analysis and publication bias test of inclusion literature were assessed by the Stata 12.0. Results：A total of 12 440 patients were enrolled in 14 clinical studies. Meta-analysis showed that the stone-free rate（SFR） was higher in the intentional preoperative D-J stent（IPS） group than in the not preoperative D-J stent（NPS） group（RR=1.08，95%CI=1.02 to 1.14，P=0.007）. SFR of the renal and proximal ureteral calculi was higher in the IPS group than in the NPS group（RR=1.46，95%CI=1.05 to 2.03，P=0.02），and there was no signifi－cant difference in SFR of distal ureteral calculi between IPS group and NPS group（RR=1.14，95%CI=0.92 to 1.42，P=0.24），and it was the same result in terms of operative time（SMD=-0.21，95%CI=-0.73 to 0.32，P=0.44） and complications（RR=0.78，95%CI=0.52 to 1.18，P=0.25）. Conclusion：Preoperative D-J stent for URL can increase SFR，especially for kidney and proximal ureteral stones patients.