原位回肠和原位乙状结肠新膀胱术后尿动力学检测和尿控水平对比的Meta分析  

Comparison of urodynamic parameters and continence between orthotopic ileal and sigmoid neobladder:aMeta-analysis

作　　者：王大川 王璟琦[2] 许腾飞 范帅帅 王正 WANG Da-chuan;WANG Jing-qi;XU Teng-fei;FAN Shuai-shuai;WANG Zheng(Shanxi Medical University,Taiyuan 030001;Department of Urology,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第一医院泌尿外科,山西太原030001

出　　处：《现代泌尿外科杂志》2019年第8期654-659,共6页Journal of Modern Urology

摘　　要：目的通过术后尿动力学检测和尿控水平的对比情况,探讨原位回肠和原位乙状结肠新膀胱的临床疗效。方法计算机检索PubMed、Embase、the Cochrane Library、Wiley、中国知网、万方数据和维普网等数据库,搜索2018年6月前关于原位回肠和原位乙状结肠新膀胱手术疗效对比的研究,提取数据后采用STATA 14.0软件进行Meta分析。结果共纳入17项研究,1 387例患者。回肠组新膀胱最大容量和顺应性明显高于乙状结肠组(WMD=49.515,P=0.000;WMD=21.638,P=0.000),充盈期膀胱压明显低于乙状结肠组(WMD=-2.481,P=0.000),乙状结肠组新膀胱残余尿量明显低于回肠组(WMD=5.924,P=0.000),二者最大尿流率无明显差异(WMD=0.093,P=0.717);日间尿控率均明显高于夜间尿控率(RR=0.494,P=0.000;RR=0.438,P=0.000),回肠组夜间尿控率明显高于乙状结肠组(RR=0.701,P=0.000),二者的日间尿控率无明显差异(RR=0.771,P=0.087)。结论尽管原位乙状结肠新膀胱可能为患者提供了更满意的排空感,但回肠新膀胱更易满足容积大、顺应性好、充盈期压力小和昼夜尿控率高的理想特点,故而本研究认为回肠比乙状结肠更适合用于新膀胱重建。Objective To analyze the clinical efficacy of orthotopic ileal neobladder and sigmoid neobladder by examining the postoperative urodynamic parameters and urinary continence.Methods Studies about orthotopic ileal and sigmoid neobladder published before July,2018 were searched in PubMed,Embase,Cochrane Library,Wiley,CNKI,Wanfang Data,and VIP database.The data were extracted and analyzed with STATA14.0.Results A total of 17 studies with1 387 patients were included in this Meta-analysis.The data showed that ileal neobladder group exhibited larger capacity(WMD=49.515,P=0.000),better compliance(WMD=21.638,P=0.000)and lower pressure at max capacity(WMD=-2.481,P=0.000).The sigmoid neobladder group had significantly smaller post-voiding residual volume(WMD=5.924,P=0.000).There was no significant difference in the max voiding flow rate between the two groups(WMD=0.093,P=0.717).The daytime continence rates in both groups were significantly higher than nighttime continence rates(RR=0.494,P=0.000;RR=0.438,P=0.000).The ileal neobladder group had significantly higher nighttime continence rate than the sigmoid neobladder group(RR=0.701,P=0.000).There was no significant difference in daytime continence rate between the two groups(RR=0.771,P=0.087).Conclusion Ileal neobladder is more effective than sigmoid neobladder in providing patients with bladders with larger capacity,better compliance,lower pressure and higher continence rate,although sigmoid neobladder may enable patients to experience a better sense of voiding.This study suggests that ileum is more suitable than sigmoid for reconstructing a new bladder.

关 键 词：原位新膀胱 回肠 乙状结肠 尿动力学 尿控 

分 类 号：R699.5[医药卫生—泌尿科学]