非复杂性输尿管镜碎石术后留置输尿管支架管必要性的Meta分析

Necessity of placement of ureteral stents after uncomplicated ureteroscopy lithotripsy for ureteral calculi:a meta-analysis

目的：评价非复杂性输尿管镜碎石术后常规留置输尿管支架管的必要性。方法：计算机检索中国生物医学文献数据库（CBM）、中国学术期刊网络出版总库（CNKI）、维普资讯中文科技期刊数据库（VIP）和万方数据知识服务平台（WANFANG datebase）、MEDLINE、EMbase、Cochrane图书馆,纳入经输尿管碎石术后留置输尿管支架管的随机对照研究（RCT）。主要评价两组研究对象的手术时间、术后结石清除率、下尿路症状（排尿困难、血尿、尿频）及再入院率、泌尿系感染率。采用RevMan5.2进行Meta分析。结果：共纳入17个RCT,涉及经输尿管镜下碎石研究对象1 323例。Meta分析结果表明,非复杂性输尿管镜碎石术后：（1）两组研究对象手术时间的差异有统计学意义（WMD=3.61,95%CI：1.45~5.76,P=0.001）。（2）两组研究对象结石清除率的差异无统计学意义（RR=0.98,95%CI：0.96~1.00,P=0.09）。（3）两组研究对象排尿困难发生率的差异有统计学意义（RR=2.21,95%CI：1.38~3.53,P=0.0009）。（4）两组研究对象尿频发生率的差异有统计学意义（RR=1.54,95%CI：1.06~2.23,P=0.002）。（5）两组研究对象血尿发生率的差异有统计学意义（RR=1.85,95%CI：1.17~2.90,=0.008）。（6）两组研究对象再入院率的差异有统计学意义（RR=0.42,95%CI：0.23~0.78,P=0.006）。（7）两组研究对象泌尿系感染的差异无统计学意义（RR=0.32,95%CI：0.06~1.62,P=0.17）。结论：非复杂性输尿管镜下碎石术后没有必要常规留置支架管,术后不留置支架管并不影响术后研究对象的结石清除率、泌尿系感染发生率等,但能够缩短手术时间,减少术后下尿路症状发生率及再入院率。

Objective：The aim of this study was to evaluate the necessity for stenting after uncomplicated ureteroscopic lithotripsy.Method：A systematic search of CBM,CNKI,VIP,WANFANG datebase,PubMed,Embase and the Cochrane Library was performed to identify all randomized controlled trials.All relevant studies were on the outcomes and complications of ureteroscopic lithotripsy in the management of ureteral stones with or without a ureteral stent.The outcomes assesed include operative time,postoperative stone-free rate,lower urinary tract symptoms（dysuria,urinary frequency,hematuria）,rehospitalization rate（unplanned medical visits）,urinary tract infection.The Cochrane Collaboration Review Manager software（RevMan 5.2）was used for meta-analysis.Result：A total of 17 randomized controlled trials were enrolled for analysis and involved 1323 patients.The result of Meta-analysis show that after uncomplicated ureteroscopy lithotripsy,There was a statistically significant difference in Mean Operative Time（WMD= 3.61,95%CI：1.45-5.76,P=0.001）,Dysuria rate（RR=2.21,95%CI：1.38-3.53,P=0.0009）,Urinary frequence rate（RR=1.54,95%CI：1.06-2.23,P=0.002）,Hematuria rate（RR=1.85,95%CI：1.17-2.90,P=0.008）,rehospitalization rate（RR=0.42,95%CI：0.23-0.78,P=0.006）between the two groups,There was no statistically significant difference in stone-free rate（RR=0.98,95%CI：0.96-1.00,P=0.09）and Urinary tract infections（RR=0.32,95%CI：0.06-1.62,P=0.17）.Conclusions：This meta-analysis reveals that Ureteral stenting after uncomplicated ureteroscopic lithotripsy could be unnecessary.Without indwelling Stents do not improve stone-free rate,uronary infections rate but can reduce mean operative time,dysuria rate,urinary frequence rate,hematuria rate,rehospitalization between the two groups.