肾移植术中常规安置双J管的有效性和安全性系统评价（多中心资料研究）

Efficacy and safety of routine intraoperative insertion of double-J stents in kidney transplantation： a systematic review

目的评价。肾移植术中常规安置双J管预防尿瘘和尿路梗阻的有效性及安全性。方法采用Cochrane系统评价方法，检索Medline、荷兰医学文摘（Embase）、Cochrane图书馆、中国生物医学文献数据库（CBM）和中国知识资源总库（CNKI）以及。肾移植相关中英文杂志，收集所有肾移植术中常规安置双J管的随机对照试验（RCT）和半随机对照试验病例。术中常规放置双J管者为试验组，不放置者为对照组。采用Revman软件（5．0版）对数据进行Meta分析。结果共纳入10个RCT，1616例肾移植受者。试验组尿漏和尿路梗阻的总体发生率为1．4％，对照组为9．7％；试验组尿路感染的发生率为28．0％，对照组为18．3％，差异均有统计学意义。试验组和对照组的受者及移植肾存活率相近，差异均无统计学意义。试验组和对照组急性排斥反应、移植肾功能恢复延迟和血尿的发生率相近，差异均无统计学意义。双J管留置时间无论长短（≤4周或者〉4周），试验组尿瘘和尿路梗阻的发生率均低于对照组，差异有统计学意义。双J管留置时间≤4周的RCT中，试验组尿路感染的发生率高于对照组，差异有统计学意义。双J管留置时间≤4周者的尿路感染发生率低于〉4周者。无论是否留置双J管，长疗程应用抗菌药物者（〉5d）尿路感染的发生率低于短期（≤5d）应用者。结论肾移植手术中常规放置双J管能明显降低尿瘘和尿路梗阻的发生率。常规放置双J管，尿路感染的发生率升高，但并不影响预后，受者术后抗生素至少应持续使用到取出双J管后。双J管在体内的留置时间不应长于4周，尿管留置的时间应根据受者的具体情况来决定。

Objective To systematically evaluate the effect of routine insertion of double-J stents to prevent major urological complications （MUCs） in kidney transplant recipients. Methods Medline, Embase, Cochrane Library, and Chinese Biomedicine database were searched to locate relevant randomized controlled trials （RCT）. Data extraction and assessment of methodologic quality were performed independently by two reviewers. Meta-analysis was performed by Revman 5.0 software. Results Ten RCT （including 1616 patients） were identified. By comparing the routine stent group with the no stent group, the meta-analysis showed： （1） incidence of urine leak, urinary obstruction and UTI was 4 times lower,6 times lower, increased by 52% respectively （P〈0. 0001 ）; （2） Patient and graft survival, rate of acute rejection,delayed graft function and hematuria were of no significant difference. In subgroup analysis, it was found： （1） Compared with the no stent group, the group in which stent duration was ≤ 4 weeks had a lower incidence of MUCs and a higher incidence of UTI; meanwhile, the group in which stent duration was 〉 4 weeks had a much lower incidence of MUCs and the rate of UTI was increased without significant difference; （2） In the RCT of which urethral catheter duration was 〈 5 days,there were no significant differences between the two groups in MUCs and UTI. In the RCT of which urethral catheter duration was ≥ 5 days, the stent group had a lower incidence of MUCs and a higher incidence of UTI. Conclusion Routine stenting reduces the incidence of MUCs. Although the double-J stent increases the risk of UTI, it seems that UTI doesn＇t affect the outcome of transplantation. The stent duration should be within 4 weeks. For the stent recipients, the longer duration of urethral catheter, the lower incidence of MUCs, the higher incidence of UTI; thus, it is up to clinicians to decide the optimal duration of urethral catheter. Long term prescription of 480 mg cotrimoxazole once daily, from the operation day till after stent removal, effectively reduces the risk of UTI associated with stent placement.