肾结石/上段输尿管结石体外冲击波碎石术后应用坦索罗辛的Meta分析

Role of tamsulosin treatment for renal calculi and upper ureteral calculi after extracorporeal shock wave lithotripsy:a Meta-analysis

目的评价坦索罗辛是否可应用于肾结石、上段输尿管结石体外冲击波碎石(ESWL)术后促进碎石的排出并具有镇痛疗效。方法计算机检索PubMed、EMbase、Cochranedatabase、CBM、CNKI和万方数据库,查找所有比较坦索罗辛和对照组在肾结石和上段输尿管结石ESWL术后碎石清除率和疼痛情况的随机对照试验(RCT),检索时限均为建库至2012年2月28日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.1进行Meta分析。结果上段输尿管结石纳入3个研究,213例患者;肾结石纳入5个研究,509例患者。Meta分析结果显示:(1)在疼痛影响方面:与对照组相比,坦索罗辛对肾结石ESWL术后可减少肾绞痛发生的机会[RR=0.36,95%CI(0.26,0.49),P<0.00001],但对上段输尿管结石ESWL术后无明显镇痛疗效[SMD=-0.62,95%CI(-1.42,0.17),P=0.12];(2)在碎石清除率方面:与对照组相比,坦索罗辛均可增加肾结石ESWL术后的碎石清除率[RR=0.71,95%CI(0.58,0.87),P=0.0008]和上段输尿管结石ESWL术后的碎石清除率[RR=0.63,95%CI(0.41,0.95),P=0.03]。结论坦索罗辛可用于肾结石和上段输尿管结石ESWL术后增加碎石的清除率,并且对肾结石的患者有减少肾绞痛发生的作用,对上段输尿管结石的镇痛作用不明显;但因原始研究数量尚少,建议临床上审慎使用;需要更多高质量、大样本的RCT进一步论证。

Objective To evaluate the role of tamsulosin in analgesia and clearance of renal calculi and upper ureteral calculi after extracorporeal shock wave lithotripsy(ESWL)by the meta-analysis of randomized controlled trials.Methods We searched PubMed,Embase,Cochrane,CBM,CNKI and Wanfang database from their establishment to February 2012 for collecting the randomized controlled trials about tamsulosin for the treatment of renal calculi and upper ureteral calculi after extracorporeal shock wave lithotripsy,and the references of those RCTs were also searched by hand.Results Three studies about upper ureteral calculi involving 213 patients and five studies about renal calculi involving 509 patients were included.The results of meta-analyses showed that:(1)analgesia indicator:compared with controlled group,tamsulosin can reduce the incidence of renal colic in renal calculi patients after ESWL(RR=0.36,95% CI 0.26 to 0.49,P<0.00001),but it had no effect on the patients with upper ureteral calculi(SMD=-0.62,95% CI-1.42 to 0.17,P=0.12);(2)clearance rate of stone fragments indicator:compared with controlled group,tamsulosin can both increase the clearance rate of renal calculi(RR=0.71,95% CI 0.58 to 0.87,P=0.0008)and upper ureteral calculi(RR=0.63,95% CI 0.41 to 0.95,P=0.03)after ESWL.Conclusions The current evidence demonstrate that tamsulosin can facilitate clearance of stone fragments in renal and upper ureteral calculi and has analgesia effect on renal calculi after ESWL.But tamsulosin has no similar effect on upper ureteral calculi.For the small amount of original studies,a prudent choice is suggested;and more high-quality,large-sample studies are need.