不同腹膜透析置管方式在发生导管功能障碍比较的网状Meta分析

Comparison of different techniques for peritoneal dialysis catheter insertion in catheter mechanical dysfunction: a network meta-analysis

目的系统评价不同腹膜透析置管方式对导管功能障碍的影响。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集不同腹膜透析置管方式比较的随机对照试验和队列研究,检索时限均为建库起至2018年3月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用ADDIS 1.16.6软件进行网状Meta分析。结果共纳入33个研究(9个随机对照试验和24个队列研究),包括3 301例患者。网状Meta分析结果显示:在腹透导管功能障碍发生率上,腹腔镜术置管法优于经皮穿刺术置管法[OR=3.60,95%CI(1.64,15.38)]和开放性手术置管法[OR=5.86,95%CI(2.68,14.53)]。经皮穿刺术置管法有少于开放性手术置管法的趋势,但差异无统计学意义。结论从减少腹透导管导管功能障碍方面考虑,腹腔镜可能是腹膜透析导管插入的最佳技术。不同腹膜透析导管插入技术有其自身的优点,我们应结合患者自身与置管技术的特点进行个体化选择。

Objectives To systematically review the influence for catheter mechanical dysfunction of different peritoneal dialysis catheterization methods. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials(RCTs) and cohort studies on comparisons of different peritoneal dialysis catheterization from inception to March 31 st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using ADDIS 1.16.6 software. Results A total of 33 studies(9 RCTs and 24 cohort studies) involving 3 301 patients were included. Network meta-analysis showed that the incidence of catheter mechanical dysfunctionwas the least and had statistically significant difference compared with that in percutaneous catheterization(OR=3.60;95%CI, 1.64 and 15.38)and open surgery catheterization(OR=5.86;95%CI, 2.68 and 14.53). Percutaneous catheterization was superior to open surgery catheterization, but there was no significant difference. Conclusions Laparoscopic catheterization may be the best technique for catheter insertion in peritoneal dialysis considering catheter dysfunction. Each technology has its own advantages. Choice of insertion method should be based on the characteristics of both the patient and the insertion techniques.