TURBT术中超声联合神经刺激仪定位闭孔神经阻滞的Meta分析  

Meta analysis of intraoperative ultrasound combined with nerve stimulator to locate obturator nerve block in TURBT

作　　者：赵犁天 冯德超 杨玉帛 白云金 韩平[2] 魏武然[2] ZHAO Li-tian;FENG De-chao;YANG Yu-bo;BAI Yun-jin;HAN Ping;WEI Wu-ran(Third Department of General Surgery,Gongxian People’s Hospital in Yibin City,Yibin Sichuan 644500,China;Department of Urology Surgery/Institute of Urology Surgery,West China Hospital of Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]宜宾市珙县人民医院外三科,四川宜宾644500 [2]四川大学华西医院泌尿外科/四川大学华西医院泌尿外科研究所,四川成都610041

出　　处：《局解手术学杂志》2021年第1期12-17,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZY2016104);四川省科技厅重点研发项目(2020YFH0099)。

摘　　要：目的探讨经尿道膀胱肿瘤切除(TURBT)术中超声引导联合神经刺激仪进行闭孔神经阻滞(ONB)的有效性和安全性。方法系统性检索PubMed、the Cochrane Library、Embase、万方、中国知网和维普数据库,搜集在TURBT中采用超声联合神经刺激仪定位ONB的临床研究,检索时限为建库之初至2020年5月。2位独立研究人员根据标题、摘要和全文筛选符合纳入标准的文献并提取资料。最终纳入5篇随机对照研究,每篇研究分为超声引导组(超声组)和神经刺激仪联合超声引导组(联合组),使用相对危险度(RR)作为效应量,使用Cochrane风险偏倚评估表评估纳入研究的质量,并使用Stata 14.2汇总提取的研究数据。结果联合组和超声组ONB的成功率比较,差异有统计学意义(RR1.17,95%CI1.07~1.27),且研究间无明显异质性(I2=0.0%,P=0.951)。2组一次穿刺成功率(RR1.12,95%CI0.99~1.26)、穿刺次数(WMD0.18,95%CI-0.07~0.43)、操作时间(SMD1.25,95%CI-1.32~3.81)、起效时间(WMD-2.78,95%CI-5.62~0.05)比较,差异无统计学意义(P>0.05)。结论超声引导联合神经刺激仪可明显提高ONB的成功率。Objective To investigate the efficacy and safety of ultrasound guidance combined with nerve stimulator for obturator nerve block(ONB)in transurethral resection of bladder tumors(TURBT).Methods Systematic retrieval of PubMed,the Cochrane Library,Embase,Wanfang,CNKI and VIP database was performed to collect the clinical study of ONB localization with ultrasound combined with nerve stimulator in TURBT,and the retrieval time was from the beginning of the database establishment to May 2020.Two independent researchers screened the documents that met the inclusion criteria based on the title,abstract and full text,and extracted data.Finally,5 randomized controlled studies were included,each of which was divided into the ultrasound guidance group(ultrasound group)and the nerve stimulator combined with ultrasound guidance group(combined group).The relative risk(RR)was used as the effect size,the Cochrane risk bias assessment form was used to assess the quality of the included studies,and the Stata 14.2 was used to summary the extracted study data.Results There was statistically significant difference in the success rate of ONB between the combined group and the ultrasound group(RR:1.17,95%CI:1.07~1.27),and there was no significant heterogeneity among those studies(I2=0.0%,P=0.951).There was no statistically significant difference in the success rate of one-time puncture(RR:1.12,95%CI:0.99~1.26),the puncture times(WMD:0.18,95%CI:-0.07~0.43),the operation time(SMD:1.25,95%CI:-1.32~3.81)and the onset time(WMD:-2.78,95%CI:-5.62~0.05)between the two groups.Conclusion Ultrasound guidance combined with nerve stimulator can significantly improve the success rate of ONB.

关 键 词：闭孔神经阻滞 经尿道膀胱肿瘤切除术 神经刺激仪 超声引导 META分析 

分 类 号：R737.14[医药卫生—肿瘤]