经输尿管镜碎石术后双J管留置必要性及安全性的系统评价

目的系统评价经输尿管镜碎石术后双J管留置的必要性及安全性。方法计算机检索MEDLINE、EMbase、Cochrane图书馆、中国生物医学文献光盘数据、中文科技期刊全文数据库、CNKI,纳入经输尿管碎石术后双J管留置的随机对照试验（RCT）。检索时间为2000年～2010年3月。对纳入研究进行质量评价,提取有效数据,采用RevMan5.0进行Meta分析。结果共纳入6个RCT,涉及输尿管镜下碎石患者543例。Meta分析结果表明,单纯性输尿管结石患者经输尿管镜碎石术后：①两组术后患者结石清除率差异无统计学意义RR=0.45,95%CI（0.98,1.01）,P=0.15];②两组术后患者排尿困难发生率差异无统计学意义RR=1.35,95%CI（0.99,1.84）,P=0.06];③两组术后患者血尿发生率差异无统计学意义RR=2.12,95%CI（1.00,4.49）,P=0.05];④两组术后患者尿频发生率差异有统计学意义RR=2.17,95%CI（1.13,4.17）,P=0.02];⑤两组术后患者第三天躯体疼痛评分差异有统计学意义WMD=0.94,95%CI（0.47,1.42）,P=0.0001];⑥两组患者手术时间差异有统计学意义WMD=3.57,95%CI（1.40,5.72）,P=0.001]。术后不予留置双J管能明显减少患者手术时间及术后因双J管引起的膀胱刺激症状,提高患者术后生活质量,但并不影响术后结石的清除率。结论经输尿管镜碎石术后,常规留置双J管可能不必要,且可减少留置导致的副作用。但由于纳入试验的方法学质量普遍较低,期待更多设计合理的大样本随机双盲对照试验提供高质量的证据。

Necessity and Safety of Ureteral Stenting after Ureteroscopic Lithotripsy in Treatment of Ureteral Calculi: A Systematic Review

Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi.Methods We electronically searched MEDLINE,EMbase,Cochrane Library,CBM,VIP and CNKI to collect randomized controlled trials （RCTs） involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010.The quality of included trials was assessed.Data were extracted and analyzed with RevMan5.0 software.Results Six RCTs involving 543 patients were identified.The results of meta-analysis showed that：a） There was no statistical difference between two groups in stone clearance rate （RR=0.45,95% CI 0.98 to 1.01,P=0.15）,dysuria rate （RR=1.35,95% CI 0.99 to 1.84,P=0.06）,and hematuria rate （RR=2.12,95% CI 1.00 to 4.49,P=0.05）;b） There was statistical difference between two groups in frequent micturition rate （RR=2.17,95% CI 1.13 to 4.17,P=0.02）,the mean visual analog score 3 days postoperatively （WMD=0.94,95% CI 0.47 to 1.42,P=0.000 1）,and the operation time （WMD=3.57,95% CI 1.40 to 5.72,P=0.001）.Without postoperative ureteral stenting can shorten the operation time,decrease the irritation signs of bladder,and can improve quality of postoperative life without influence on stone clearance.Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety.More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.