体外冲击波碎石术前置入输尿管支架治疗输尿管结石价值的系统评价

目的系统评价体外冲击波碎石术（ESWL）前置入输尿管支架的价值。方法计算机检索Cochrane图书馆临床对照试验注册中心CCTR（2010.4）、MEDLINE（OVID,1950～2010.4）、EMbase（1966～2010.4）、CBM（1978～2010.4）、CNKI（1979～2010.4）和VIP（1989～2010.4）,手工检索相关文献,纳入在ESWL前置入输尿管支架治疗输尿管结石的随机对照试验（RCT）。按Cochrane评价员手册5.0.1版评估纳入研究的偏倚风险,并用RevMan5.0软件进行统计分析。结果共纳入3个RCT,共319例输尿管结石患者。其研究质量均为C级。Meta分析结果显示：①疗效指标：ESWL前置入输尿管支架在结石完全清除率、碎石次数、碎石冲击波频率、碎石冲击波能量方面并未表现出较好的疗效,其WMD（95%CI）分别为1.10（0.87,1.38）、0.43（–1.05,0.19）、0.00（–0.25,0.25）、0.20（–0.05,0.46）。②术后并发症发生率：ESWL前置入输尿管支架术后较易发生排尿困难、镜下血尿、肉眼血尿、脓尿、尿培养阳性、耻骨上疼痛,其RR（95%CI）分别为2.30（1.62,3.26）、2.66（1.97,3.58）、6.50（1.50,28.15）、1.78（1.44,2.21）、2.13（1.71,2.64）和3.10（1.59,6.04）,且无助于预防石街形成RR=0.39,95%C（I0.03,4.58）]。结论现有证据表明,ESWL前置入输尿管支架的方法不可取。因纳入研究质量不高且例数较少,上述结论尚期待更多高质量的试验加以验证。

The Value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy:A Meta-analysis

Objective To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Litho-tripsy（ESWL）.Methods We searched the Cochrane Central Register of Controlled Trials（Issue 4,2010）,MEDLINE（OVID 1950 to April 2010）,EMbase（1979 to April 2010）,CBM（1978 to April 2010）,CNKI（1979 to April 2010）,and VIP（1989 to April 2010）,and manually searched journals as well.All the randomized controlled trials（RCTs） of treating ureteral stone with ESWL after stent placement were included.We evaluated the risk of the bias of the included RCTs ac-cording to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1.The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis.Results Three RCTs with C-level evidence involving 319 ureteral stone patients were identi ed.The results of meta-analyses showed that： a） E ect of treatment： The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate（WMD= 1.10,95%CI 0.87 to 1.38）,the quantity of lithotripsy（WMD= 0.43,95%CI – 1.05 to 0.19）,the frequency of shock wave（WMD= 0.00,95%CI – 0.25 to 0.25）,and the power of shock wave（WMD= 0.20,95%CI – 0.05 to 0.46）;and b） Postoperative complications： The ureteral stent placement were prone to cause dysuria（RR= 2.30,95%CI 1.62 to 3.26）,microscopic hematuria（RR= 2.66,95%CI 1.97 to 3.58）,gross hematuria（RR= 6.50,95%CI 1.50 to 28.15）,pyuria（RR= 1.78,95%CI 1.44 to 2.21）,positive urine culture（RR= 2.13,95%CI 1.71 to 2.64）,and suprapubic pain（RR= 3.10,95%CI 1.59 to 6.04）.Conclusions Ureteral stent place-ment before ESWL is inadvisable.Multi-factors which lead to bias a ected the authenticity of our review,such as low-quality and small amount of RCTs.Further large-scale trials are required.