经皮肾镜术后造瘘管留置必要性的Meta分析及试验序贯分析  

The necessity of nephrostomy tube after percutaneous nephrolithotripsy: a meta-analysis and the trial sequential analysis

作　　者：刘亚东[1] 王俊[1] 田河[1] 刘健男[1] 冯越[1] 徐敏玲[1] 安瑞华[1] Liu Yadong Wang jun Tian he Liu Jiannan Feng Yue Xu Minling An Ruihua.(Department of Urology, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China)

机构地区：[1]哈尔滨医科大学附属第一医院泌尿外科一病房,150001

出　　处：《中华腔镜泌尿外科杂志（电子版）》2017年第1期24-28,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金(2013)项目(81370803)

摘　　要：目的通过Meta分析和试验序贯分析评价经皮肾镜碎石术后造瘘管留置的必要性。方法计算机检索Pubmed,Embase,Cochrane Library,中国知网,万方数据库并提取数据,按照纳入和排除标准收集并筛选经皮肾镜术后造瘘管留置与否的随机对照研究,检索时限从建库至2016年7月。结果符合纳入标准研究10篇,共559例患者,其中术后留置造瘘管者288例,术后未留置造瘘管者271例。meta分析结果显示,未留置造瘘管组在手术时间(MD:4.46;95%CI:0.65,8.27;P=0.02)、住院时间(MD:1.15;95%CI:0.93,1.36;P<0.01)、术后第三天疼痛指数(MD:1.65;95%CI:0.59,2.70;P=0.002)、恢复正常工作时间(MD:1.34;95%CI:0.02,2.67;P=0.045)方面明显低于术后留置造瘘管研究组。结论对于非复杂性经皮肾镜碎石取石术的患者而言,未留置造瘘管并不会增加术后发热、出血增加等不适反应。但试验序贯分析提示手术时间、术后发热、血红蛋白下降方面仍需进一步研究论证二者间差异。Objective The evaluate whether the placement of the tube should be advised after the percutaneous nephrolithotripsy by Meta-analysis and trial sequential analysis （TSA）. Methods Computer retrieval of PubMed, Embase, Cochrane, CNKI and Wanfang, according to the inclusion and exclusion criteria were collected and screened out a randomized controlled studies on whether nephrostomy tube placement after the percutaneous nephrolithotripsy, published from inception to July 2016. Results Ten studies met the inclusion criteria with a total of 559 patients, including 288 cases of nephrostomy tube placement group and 271 cases of the tubeless group. The operation time （MD： 4.46; 95% CI： 0.65, 8.27; P=0.02）, hospital stays （MD： 1.15; 95%CI： 0.93, 1.36 P〈0.01）, pain accessment （MD： 1.65;95%CI： 0.59, 2.70; P=0.002）, time to returning to work （MD： 1.34; 95% CI：0.02, 2.67; P=0.045） of tubeless group were significantly lower than the tube group. Conclusions The tubeless group will not increase the incidence of fever and bleeding for the patient with out complex percutaneous nephrolithotripsy. But the trial sequential analysis does not allow us to draw the solid conclusion in operation time, fever and hemoglobin drop.

关 键 词：肾结石 经皮肾镜 造瘘管 META 

分 类 号：R699.2[医药卫生—泌尿科学]