内镜下Dx/HA与PPC治疗小儿膀胱输尿管反流疗效的Meta分析  

A Meta-analysis of the efficacy of dextranomer/hyaluronic acid in endoscopic treatment of vesicoureteral reflux in children

作　　者：张奥 景三鹏 郭强[2] 任凯斌 吕学锋 刘百成[4] 郝川[2] Zhang Ao;Jing Sanpeng;Guo Qiang;Ren Kaibin;Lyu Xuefeng;Liu Baicheng;Hao Chuan(Graduate School of Shanxi Medical University,Taiyuan 030000,China;Department of Urology,the Second Hospital of Shanxi Medical University,Taiyuan 030000,China;Department of Reproductive Medicine,the People's Hospital of Shanxi Province,Taiyuan 030000,China;Department of Urology,the People's Hospital of Lyuliang City,Lyuliang 033000,China)

机构地区：[1]山西医科大学研究生院,太原030000 [2]山西医科大学第二医院泌尿外科,太原030000 [3]山西省人民医院生殖医学科,太原030000 [4]吕梁市人民医院泌尿外科,吕梁033000

出　　处：《国际泌尿系统杂志》2022年第1期48-53,共6页International Journal of Urology and Nephrology

摘　　要：目的系统评价内镜下聚糖酐/透明质酸共聚物(Dx/HA)与聚丙烯酸酯多元醇共聚物(PPC)治疗小儿膀胱输尿管反流(VUR)的疗效。方法检索万方、中国知网、PubMed、Embase、Web of Science数据库,筛选出自1984年至2019年12月期间符合要求的Dx/HA与PPC治疗VUR的临床对照研究,采用RevMan 5.3软件对治愈率和膀胱输尿管连接处梗阻率进行Meta分析。结果纳入7篇研究,共计969例VUR患者。PPC组的总注射治愈率(OR=0.35,95%CI:0.23~0.54,P<0.001)、单次注射治愈率(OR=0.27,95%CI:0.19~0.40,P<0.001)、单次注射高等级治愈率(OR=0.29,95%CI:0.13~0.65,P=0.003)较Dx/HA组高;两组单次注射低等级治愈率比较,差异无统计学意义(OR=0.22,95%CI:0.05~1.03,P=0.050);PPC组患者的两次注射治愈率(OR=0.34,95%CI:0.20~0.58,P<0.001)、两次注射低等级治愈率(OR=0.26,95%CI:0.09~0.72,P<0.001)、两次注射高等级治愈率(OR=0.25,95%CI:0.11~0.56,P<0.001)及多次注射术后并发膀胱输尿管连接处梗阻率均较Dx/HA组高(OR=0.30,95%CI:0.12~0.76,P=0.010)。结论内镜下PPC治疗小儿VUR具有较高的治愈率,但术后膀胱输尿管连接处梗阻率较Dx/HA高,需长期随访尽早发现梗阻并解除。Objective To evaluate the efficacy of dextranomer/hyaluronic acid(Dx/HA)versus polyacrylate polyalcohol copolymer(PPC)in endoscopic treatment of vesicoureteral reflux(VUR)in children.Methods The databases of WanFang,CNKI,PubMed,Embase and Web of Science were searched,and the clinical control study of Dx/HA and PPC in the treatment of VUR from 1984 to December 2019 were screened.The cure rate and the ureterovesical junction obstruction rate were Meta-analyzed by RevMan 5.3 software.Results A total of 969 cases of VUR were included in 7 studies.The cure rate of total injections(OR=0.35,95%CI:0.23-0.54,P<0.001),the cure rate of single injection(OR=0.27,95%CI:0.19-0.40,P<0.001)and the high-grade cure rate of single injection(OR=0.29,95%CI:0.13-0.65,P=0.003)in PPC group were higher than those in Dx/HA group.There was no significant difference in the lower grade cure rate of single injection between the two groups(OR==0.22,95%CI:0.05-1.03,P=0.050).The cure rate of two injections(OR=0.34,95%CI:0.20-0.58,P<0.001),the lower grade cure rate of two injections(OR=0.26,95%CI:0.09-0.72,P<0.001)and the high-grade cure rate of two injections(OR=0.25,95%CI:0.11-0.56,P<0.001)in PPC group were higher than those in Dx/HA group.The incidence of ureterovesical junction obstruction after multiple injections in PPC group was higher than that in Dx/HA group(OR=0.30,95%CI:0.12-0.76,P=0.010).Conclusions PPC has a high cure rate in endoscopic treatment of VUR,but the rate of postoperative ureterovesical junction obstruction is higher than that of Dx/HA,which needs long-term follow-up to find and relieve the obstruction as soon as possible.

关 键 词：内窥镜检查 膀胱输尿管反流 儿童 聚糖酐/透明质酸共聚物 

分 类 号：R726.9[医药卫生—儿科]