膀胱扩张植入术治疗原发性膀胱输尿管反流的Meta分析

Hydrodistention implantation technique as a more effective endoscopic approach for primary vesicoureteral reflux： a meta-analysis

目的 比较膀胱扩张植入术（HIT）和经尿道输尿管口下注射术（STING）治疗原发性膀胱输尿管反流（PVUR）的治愈率,为临床治疗PVUR提供参考依据.方法 通过检索万方、中国知网、Pubmed、Elsevier、EBSCO、Web of Science等数据库,筛选出自2004年以来符合要求的HIT与STING治疗PVUR的对照研究.应用RevMan 5.3软件对纳入文献进行偏倚风险评价及Meta分析.结果 总共检索出482篇文献,其中4篇英文文献被纳入研究.Meta分析结果示：HIT组单次注射治愈率较STING组高（RR=1.15,95％CI：1.07～1.25,Z=3.61,P=0.000 3）,HIT组与STING组3次注射后总治愈率无统计学差异（RR=1.14,95％CI：0.99～1.31,Z=1.80,P=0.07）;对于Ⅰ、Ⅱ级反流,HIT组与STING组单次注射治愈率无统计学差异（RR=1.05,95％CI：0.95～1.16,Z=0.94,P=0.35）;对于Ⅲ级反流,HIT组单次注射治愈率较STING组高（RR=1.20,95％CI：1.00～1.43,Z=1.97,P＜0.05）;对于Ⅳ级反流,HIT组与STING组单次注射治愈率无统计学差异（RR=1.30,95％CI：0.95～1.78,Z=1.65,P=0.10）,HIT组与STING组3次注射后总的治愈率无统计学差异（RR=1.24,95％CI：0.94～1.63,Z=1.54,P=0.12）.结论 总的来说,HIT较STING对PVUR有更高的单次注射治愈率.对于Ⅰ、Ⅱ级反流,HIT及STING均为理想的治疗手段;对于Ⅲ级反流,HIT可能是一种更为有效的内镜治疗方法.

Objective To evaluate the curative rate of hydrodistention implantation technique （HIT） versus subureteral transurethral injection （STING） for primary vesicoureteral reflux （PVUR） soas to provide its clinical therapeutic rationales.Methods From January 2004 Wanfang Datebase,China National Knowledge Internet,PubMed,Elsevier,EBSCO and Web of Science were searched with regards to evaluating the curative rate of HIT vs STING for PVUR.The qualities of selected studies were evaluated and Meta-analysis conducted with RevMan 5.3 software.Results A total of 482 foreign literatures were retrieved.And 4 English reports were selected.The results of metaanalysis indicated that the single-injection curative rate of HIT group was higher than that of STING group （RR=1.15,95%CI：1.07-1.25,Z=3.61,P=0.000 3）.However,no significant difference existed in overall curative rate after three injections between two groups （RR=1.14,95%CI：0.99-1.31,Z =1.80,P =0.07）.For grades Ⅰ ＆ Ⅱ PVUR,no inter-group statistical difference existed in single-injection curative rate （RR=1.05,95%CI：0.95-1.16,Z =0.94,P =0.35）.For grade Ⅲ PVUR,the single-injection curative rate of HIT group was higher than that of STING group （RR =1.20,95%CI：1.00-1.43,Z =1.97,P〈0.05）.For grade IV PVUR,no significant inter-group difference existed in single-injection curative rate （RR =1.30,95%CI：0.95-1.78,Z =1.65,P =0.10） and overall curative rate after three injections （RR =1.24,95 % CI：0.94-1.63,Z =1.54,P =0.12）.Conclusions HIT group was higher than STING group in single-injection curative rate of PVUR.Both HIT and STING are efficacious for grades Ⅰ and Ⅱ PVUR while HIT is more ideal for grade Ⅲ PVUR.