输尿管结石体外冲击波碎石后盐酸坦索罗辛辅助排石的有效性及安全性Meta分析

Efficacy and safety of tamsulosin hydrochloride after extracorporeal shockwave lithotripsy for ureteral stones: a meta-analysis

【目的】系统评价盐酸坦索罗辛在输尿管结石体外冲击波碎石后辅助排石的有效性及安全性。【方法】检索PubMed、Embase、Cochrane library、万方、维普及知网中关于输尿管结石体外冲击波碎石后盐酸坦索罗辛辅助排石治疗的RCT文献,检索时间为建库至2018年9月,按纳入排除标准筛选文献后,进行资料提取及文献质量评价,采用stata13.0和RevMan5.3软件对数据行Meta分析。【结果】纳入中英文文献16篇,共1 398例患者,其中盐酸坦索罗辛组705例,对照组693例,Meta分析结果显示:坦索罗辛组的排石率高于对照组,差异有统计学意义,[OR=2.85,95%CI(2.19,3.70),P=0.00];盐酸坦索罗辛对上输尿管结石排石率的提高更为显著,[OR=3.08,95%CI(1.77,5.36),P=0.00];大剂量盐酸坦索罗辛(0.4 mg)辅助排石效率更高,[OR=2.93,95%CI(2.21,3.90),P=0.00];坦索罗辛组的排石时间明显缩短,差异有统计学意义[SMD=-0.85,95%CI(-1.33,-0.36),P=0.001];坦索罗辛组的肾绞痛发生率低,止痛药需求少,且药物本身的不良反应少,患者容易耐受。【结论】输尿管结石体外冲击波碎石后使用盐酸坦索罗辛辅助排石安全、有效,可在临床上推广使用。

【Objective】To systematically evaluate the efficacy and safety of tamsulosin hydrochloride for ureteral calculi after extracorporeal shockwave lithotripsy.【Methods】RCT literatures about tamsulosin hydrochloride for ureteral calculi after extracorporeal shockwave lithotripsy were retrieved from PubMed,Embase,Cochrane library,Wanfang database,VP information resource system and Chinese journal full text database (CNKI).The retrieval time was from the establishment of the database to September 2018.After screening the literatures according to inclusion and exclusion criteria,the data were extracted and literature quality was evaluated.The data were meta-analyzed by using Stata 13.0 and RevMan 5.3 softwares.【Results】A total of 1398 cases were included in 16 Chinese and English literatures,including 705 cases in the tamsulosin hydrochloride group and 693 cases in the control group.Meta-analysis results showed that stone expulsion rate in the tamsulosin hydrochloride group was higher than that in the control group,and the difference was statistically significant [OR=2.85,95% CI (2.19,3.70),P=0.00].The stone expulsion rate of tamsulosin hydrochloride for upper ureteral calculi increased more significantly [OR=3.08,95% CI (1.77,5.36),P=0.00].High dose of tamsulosin hydrochloride (0.4mg) was more effective in stone expulsion [OR=2.93,95% CI (2.21,3.90),P=0.00].The stone expulsion time of the tamsulosin hydrochloride group was significantly shortened,and the difference was statistically significant (SMD=-0.85,95% CI (-1.33,-0.36),P= 0.001).There was lower incidence of renal colic,less demand for analgesics,and fewer adverse reactions in the tamsulosin hydrochloride group,so the patients were easy to tolerate.【Conclusion】Tamsulosin hydrochloride is safe and effective for ureteral calculi after extracorporeal shockwave lithotripsy,and can be widely used in clinic.