双J管留置时间影响输尿管结石合并感染治疗效果的Meta分析  

Meta-analysis of curative effect of double-J tube indwelling time on ureteral calculi complicated with infection

作　　者：杨均成 邵志强[2] 卢茂凯 王浩 刘子丰 刘宗毅 郭丰富[2] Yang Juncheng;Shao Zhiqiang;Lu Maokai;Wang Hao;Liu Zifeng;Liu Zongyi;Guo Fengfu(Weifang Medical University,Weifang 261053.China;Department of Urology,the Peoples Hospital of Unyi City,Linyi 276000,China;Graduate School of Shandong First Medical University,Taian 271000,China)

机构地区：[1]潍坊医学院,261053 [2]临沂市人民医院泌尿外科,276000 [3]山东第一医科大学(山东省医学科学院)研究生院,泰安271000

出　　处：《国际泌尿系统杂志》2021年第4期654-658,共5页International Journal of Urology and Nephrology

基　　金：山东省自然科学基金(ZR2013HL019)。

摘　　要：目的探讨双J管留置时间对输尿管结石合并感染治疗疗效的影响:方法检索PUhMed、Cochmne、Medline、Embase、万方医学、中国知网等数据库。纳人符合筛选标准的文献,并按照双J管留置时间的不同将纳入研究的患者分为置管7 d组和置管>7 d组进行比较,对比分析两组患者留置双J管前后的血白细胞水平、尿白细胞水平、结石直径、手术时间、术后住院时间、结石清除率和术后并发症发生率指标。结果固定效应模型Meta分析结果显示:①两组患者置管前的血白细胞(SMD=-0.10,95%CI:-0.29〜0.09,Z=1.04,P=0.30)及尿白细胞水平(SMD=-0.13,95%CI:-0.26〜0.01,Z=1.76,P=0.08)比较,差异无统计学意义;置管7 d组患者置管7 d后的血白细胞水平高于置管>7 d组,差异有统计学意义(SMD=0.19,95%CI:0.04〜0.34,Z=2.51,P=0.01);两组置管7 d后的尿白细胞水平比较,差异无统计学意义(SMD=-0.02,95%CI:-0.17〜0.13,Z=0.28,P=0.78);两组的结石直径(SMD=-0.14,95%CI:-0.30〜0.03,Z=1.61,P=0.11)、手术时间(SMD=0.84,95%CI:-0.04〜1.73,Z=1.87,P=0.06)、术后1个月的结石清除率(OR=1.06,95%CI:0.56〜1.99,之=0.17,P=0.87)及术后并发症发生率(OR=1.01,95%CI:0.74〜1.38,Z=0.06,P=0.95)比较,差异均无统计学意义;置管7 d组患者的术后住院时间短于置管>7 d组,差异有统计学意义(SMD=-0.13,95%CI:-0.25〜-0.01,Z=2.09,P=0.04)。结论延长双J管留置时间在减轻全身炎症反应方面有积极作用,在手术时间、术后1个月结石清除率及术后并发症发生率方面无明显优势,在术后住院时间方面有消极作用,因此在输尿管结石合并上尿路感染的诊疗过程中,可在炎症得到控制的情况下尽量缩短双J管的留置时间,以减少置管并发症带给患者的痛苦,同时使患者可以尽早手术,尽早康复。Objective To explore*the effect of double-J tube indwelling time on ureteral calculi complicated with infection.Methods Databases such as PubMed,Cochrane,Medline,Embase,Wanfang Medicine,CNKI were searched.The literatures that met the screening criteria were included,and the included patients were divided into catheterization group for 7 days and catheterization group for>7 days for comparison according to the different indwelling time of double-J tubes.The difference between blood and urine white blood cell count,stone diameter,operation time,postoperative hospital stay,stone clearance rate and postoperative complication rate before and after indwelling douhle-J tube was analyzed and studied.Results Meta-analysis results of fixed effect model showed that(1)There was no significant difference in blood white blood cell(SMD=-0.10,95%CI:-0.29-0.09,Z=1.04,P=0.30)and urine white blood cell level(SMD=-0.13,95%CI:-0.26-0.01,Z=1.76,P=0.08)between 2 groups before catheterization.The level of white blood cells in the 7 days group was higher than that in the 7 days>group(SMD=0.19,95%CI:0.04-0.34,Z=2.51,P=0.01).There was no statistical significance in the level of urine white blood cells between the two groups 7 days after catheterization(SMD=-0.02,95%CI:-0.17-0.13,Z=0.28,P=0.78).Stone diameter(SMD=-0.14,95%CI:-0.30-0.03,Z=1.61,P=0.11)and operation time(SMD=0.84,95%CI:-0.04-1.73,Z=1.87,P=0.06),stone clearance rate one month after surgery(OR=1.06,95%CI:0.56-1.99,Z=0.17,P=0.87)and incidence of postoperative complications(OR=1.01,95%CI:0.74-1.38,Z=0.06,P=0.95),there was no statistical significance(P<0.05).The postoperative hospitalization time of patients in the 7-day catheterization group was shorter than that in the 7-day catheterization group,the difference was statistically significant(SMD=-0.13,95%CI:-0.25--0.01,Z=2.09,P=0.04).Conclusions Prolonging the retention time of douhle-J tube has a positive effect on reducing systemic1 inflammatory response.It has no obvious advantages in operation time,stone removal rate at 1 mont

关 键 词：尿路结石 双J管 感染 

分 类 号：R699[医药卫生—泌尿科学]