宫颈癌所致输尿管梗阻患者输尿管支架置入成功率影响因素的Meta分析

Meta Analysis of Factors Influencing Success Rate of Ureteral Stent Implantation in Patients with Ureteral Obstruction Caused by Cervical Cancer

目的通过Meta分析方法探讨影响宫颈癌所致输尿管梗阻患者的输尿管支架置入成功率的因素。方法采用计算机在PubMed、Cochrane Library、EMBase、中国医学和生物文献数据库、维普网、中国知网及万方数据知识服务平台进行系统文献检索,同时辅以手动检索,检索时间为建库至2021-07-01。由2位独立评价人员进行数据提取及方法学质量评价;采用RevMan5.3软件进行Meta分析。结果本文最终纳入6篇文献,共470例患者。Meta分析结果显示,肾积水轻度[OR=6.29,95%CI(2.64,14.96),P<0.0001]、输尿管梗阻较短[OR=5.53,95%CI(2.96,10.34),P<0.00001]、无膀胱侵犯[OR=0.25,95%CI(0.07,0.90),P=0.03]、放疗史[OR=3.16,95%CI(2.11,4.75),P<0.00001]的患者的输尿管支架置入成功率较高;原发肿瘤直径越小,输尿管支架置入成功率越高[MD=-2.96,95%CI(-3.36,-2.56),P<0.00001]。结论宫颈癌并发肾积水患者的输尿管支架置入术的总体成功率仍不理想,肿瘤直径较小、肾积水轻度、输尿管梗阻较短、无膀胱侵犯、放疗史的患者的置管成功率相对较高。

Objective To explore the factors affecting the success rate of ureteral stent implantation in patients with ureteral obstruction caused by cervical cancer through the method of Meta analysis.Methods Systematic literature retrieval was conducted by computer in PubMed,Cochrane Library,EMBase,Chinese Medical and Biological Literature Database,VIP,CNKI and Wanfang Data knowledge service platform,supplemented by manual retrieval.The retrieval time was from database establishment to 2021-07-01.Data extraction and methodological quality evaluation were performed by two independent evaluators;Meta-analysis was performed using RevMan5.3 software.Results Six articles were included in this study,with a total of 470 patients.Meta-analysis results showed that patients with mild hydronephrosis[OR=6.29,95%CI(2.64,14.96),P<0.0001],shorter ureteral obstruction[OR=5.53,95%CI(2.96,10.34),P<0.00001],no bladder invasion[OR=0.25,95%CI(0.07,0.90),P=0.03],and history of radiotherapy[OR=3.16,95%CI(2.11,4.75),P<0.00001]had higher success rate of ureteral stent placement.The smaller the diameter of primary tumor,the higher the success rate of ureteral stent implantation[MD=-2.96,95%CI(-3.36,-2.56),P<0.00001].Conclusion The overall success rate of ureteral stent implantation in patients with cervical cancer complicated with hydronephrosis is still not ideal.Patients with small tumor diameter,mild hydronephrosis,short ureteral obstruction,no bladder invasion and radiotherapy history have relatively high success rate of catheterization.