双J管在体外震波碎石术中应用的Meta分析

Meta-Analysis of the Use of Double-J Stents Prior to Extracorporeal Shockwave Lithotripsy

目的系统评价双J管在体外震波碎石术中应用的效果和安全性。方法计算机检索Cochrane图书馆(2009年第1期),PubMed、EMBASE、CBMdisc、CNKI、VIP和万方数据库,检索时间截止至2009年4月。收集双J管在体外震波碎石术中应用的随机对照试验,并按Cochrane协作网推荐的方法进行系统评价。结果共纳入4个随机对照试验,424例患者。Meta分析结果显示:碎石术3个月后结石清除率[加权均数差1.72,95%可信区间(0.95,3.10)],石街发生率[加权均数差0.77,95%可信区间(0.27,2.20)],疼痛发生率[加权均数差0.71,95%可信区间(0.26,1.91)],血尿发生率[加权均数差0.26,95%可信区间(0.04,1.92)]的差异均无统计学意义。但使用双J管会增加排尿困难发生率[加权均数差0.23,95%可信区间(0.14,0.39)]。结论在体外震波碎石术中应用双J管并不能为病人带来预期的效果,反而会增加术后排尿困难的发生率。但限于纳入研究的局限性,尚需高质量随机对照试验对在体外震波碎石术中应用双J管的疗效和安全性做进一步证实。

Objective To assess the efficacy and safety of the stentless versus double-J （D J） stent for renal pelvic stone before extracorporeal shockwave lithotripsy, and to guidance for clinical practice. Methods We searched the electronic bibliographic databases, including Cochrane Library, PubMed, EMBASE, CBMdisc, VIP, CNKI and WANGFANG to assemble the RCT of double-J （D-J） stent for renal pelvic stone before extracorporeal shockwave lithotripsy. Retrieval time is April 2009. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for data analysis. Results Four randomized trials involving 424 patients were included. The results of meta-analyses indicated： The clearance rate after three months was [WMD= 1.72, 95% CI （0.95,3.10）], the incidence of steintrasse [WMD=0.77, 95% CI （0.27,2.20）], the incidence of pain [WMD=0.71, 95%CI （0.26,1.91）] and the incidence of hematuria. [WMD=0.26, 95%CI （0.04,1.92）], and the incidence of voiding dysfunction [WMD=0.23, 95% CI （0.14,0.39）]. Conclusion No statistically significant difference between stentless versus D-J stent before extracorporeal shockwave lithotripsy is found for the incidence of clearance rate, steinstrasse and pain hematuria, D-J stent didn＇t bring better prognosis to patients. What＇s worse, in D-J stent group, the incidence of voiding dysfunction raises. There is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality randomized controlled trials is needed.