经皮肾造瘘术与逆行输尿管支架置入术治疗急性梗阻性上尿路感染围手术期结果和安全性的荟萃分析  

Meta-analysis of perioperative results and safety of percutaneous nephrostomy and retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection

作　　者：武刚 王喜东 崔元善[1] 吴吉涛[1] Wu Gang;Wang Xidong;Cui Yuanshan;Wu Jitao(Department of Urology,Yantai Yuhuangding Hospital,Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院泌尿外科,烟台264000

出　　处：《中华泌尿外科杂志》2023年第2期128-133,共6页Chinese Journal of Urology

摘　　要：目的比较经皮肾造瘘术(PCN)与逆行输尿管支架置入术(RUS)治疗急性梗阻性上尿路感染的围手术期结果和安全性。方法计算机检索Medline、Embase和Cochrane对照试验注册库,检索年限均为建库至2022年8月。文献纳入标准:①关于PCN和RUS治疗急性梗阻性上尿路感染疾病的随机对照研究(RCT);②研究提供了可供分析的准确数据,包括受试者总数和各指标的结果值;③研究的全文可供查阅,同一队列研究所发表的不同文献纳入最新发表的数据;④观察指标包括体温恢复正常时间、肌酐恢复正常时间、白细胞恢复正常时间、置管失败例数、手术时间、辐射暴露时间、术后血尿、术后发热、术后疼痛、术后造瘘管或支架管移位发生率。排除标准:①非RCT研究;②无法获取全文。由2名研究者独立筛选文献并进行文献质量评价。结果共纳入7篇文献,包括727例患者,PCN组412例,RUS组315例。荟萃分析结果显示,与RUS相比,PCN的优势在于术后血尿发生率低(OR=0.54,95%CI 0.30~0.99,P=0.040),置管失败率低(OR=0.42,95%CI 0.21~0.81,P=0.010),但RUS组受辐射暴露时间短于PCN组(MD=0.31,95%CI 0.14~0.48,P<0.01)。两种手术方式在体温恢复正常时间、肌酐恢复正常时间、白细胞恢复正常时间、手术时间、术后发热、术后疼痛、术后造瘘管或支架管移位发生率方面差异均无统计学意义(P>0.05)。结论PCN的辐射暴露时间长于RUS,但术后血尿和置管失败率低于RUS。Objective To compare the perioperative outcomes and safety of percutaneous nephrostomy(PCN)and retrograde ureteral stenting(RUS)in the treatment of acute obstructive upper urinary tract infection.Methods A comprehensive search was performed on the MEDLINE,EMBASE and Cochrane Central Register of Controlled Trials to identify relevant literatures.The retrieval period was from the establishment of the database to August 2022.Inclusion criteria:①Randomized controlled trial(RCT)of PCN and RUS in the treatment of acute obstructive upper urinary tract infection;②Studies provided accurate data for analysis,including the total number of subjects and the results of each index;③The full text of the study was available,and different literatures published in the same cohort were included in the newly published data.④The observation indexes included the time for the recovery of body temperature,creatinine,leukocyte,operation,radiation exposure,postoperative fever,postoperative pain,and the incidence of postoperative fistulotomy or stent displacement.Exclusion criteria:①non-RCT study;②unable to obtain the full text.Two researchers independently screened the literature and evaluated the literature quality,and all the statistical data were analyzed by RevMan5.3 software.Results Seven trials enrolled 727 patients were included in the meta-analysis,412 in the PCN group and 315 in the RUS group included.Meta-analysis revealed that the advantages of PCN were lower incidence of postoperative hematuria(OR=0.54,95%CI 0.30-0.99,P=0.040)and lower incidence of insertion failure(OR=0.42,95% CI 0.21-0.81,P=0.010),but the fluoroscopy time of RUS group was shorter than that of PCN group(MD=0.31,95% CI 0.14-0.48,P<0.01).Moreover,there was no significant difference in time to normalization of temperature,time to normalization of creatinine,time to normalization of WBC,operative time,postoperative fever,postoperative pain,postoperative nephrostomy tube or stent slippage rate between the two surgical methods(P>0.05).Conclusions The rad

关 键 词：经皮肾造瘘术 逆行输尿管支架置入术 随机对照试验 荟萃分析 

分 类 号：R699[医药卫生—泌尿科学]