输尿管软镜术前预置双J管临床随机对照试验的Meta分析

The clinical randomized controlled trial of presetting double-J stents before retrograde intrarenal surgery:a Meta-analysis

目的评价术前预置双J管在输尿管软镜手术中的应用价值。方法计算机检索从建库起至2021年12月期间在The Cochrane Library、PubMed、EMbase、CNKI、VIP、CBM、WanFang Data数据库中关于输尿管软镜术前预置双J管对手术疗效影响的随机对照试验(RCT)。由两名研究者单独进行文献筛选、资料提取及偏倚风险评价。结果共纳入19项RCT, 包括1 062例预置组患者和1 113例未预置组患者。Meta分析结果显示, RIRS术前预置双J管组的一次性置鞘成功率高于未预置组, 差异有统计学意义(OR=7.11, 95%CI:4.44~11.38,P<0.001)。RIRS术前预置双J管组术后1个月的结石清除率高于未预置组, 差异有统计学意义(OR=1.75, 95%CI:1.27~2.40, P=0.001)。RIRS术前预置双J管组的手术时间短于未预置组, 差异有统计学意义(MD=-5.74, 95%CI:-10.43~-1.04, P=0.020)。RIRS术前预置双J管组的输尿管损伤发生率低于未预置组, 差异有统计学意义(OR=0.23, 95%CI:0.13~0.42, P<0.001)。RIRS术前预置组术后总体并发症发生率低于未预置组, 差异有统计学意义(OR=0.43, 95%CI:0.24~0.77, P<0.005)。结论输尿管软镜术前常规预置双J管能提高一次性置鞘成功率和术后结石清除率, 降低手术时间和术后总体并发症发生率, 因此具有更高的安全性和有效性。

Objective To review the value of presetting double-J tubes before retrograde intrarenal surgery.Methods Databases including PubMed,EMbase,The Cochrane Library,CNKI,Wan-Fang,VIP and CBM were searched to collect randomized controlled trials(RCT)about the effect of preseting double-J stents before retrograde intrarenal surgery from inception to December 2021.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Results A total of 19 RCTS were included,including 1062 patients in the preset group and 1113 patients in the unpreset group.The results of Meta-analysis showed that the success rate of onetime implantation in the preconfigured double-J tube group before RIRS was higher than that in the non-preconfigured group,and the difference was statistically significant(OR=7.11,95%CI:4.44-11.38,P<0.001).The stone clearance rate one month after operation in the preconfigured double-J tube group was higher than that in the non-preconfigured group,with statistical significance(OR=1.75,95%Cl:1.27-2.40,P=0.001).The operative time in the preconfigured double-J tube group before RIRS was shorter than that in the non-preconfigured group,and the difference was statistically significant(MD=-5.74,95%CI:-10.43--1.04,P=0.020).The incidence of ureteral injury in the preconfigured double-J tube group before RIRS was lower than that in the non-preconfigured group,and the difference was statistically significant(0R=0.23,95%Cl:0.13-0.42,P<0.001).The 0-verall postoperative complication rate in the preconfigured RIRS group was significantly lower than that in the non-preconfigured RIRS group(OR=0.43,95%CI:0.24-0.77,P<0.005).Conclusions Conventional presetting double-J stents before retrograde intrarenal surgery can reduce the operation time,improve the success rate of one-off placement of ureteral access sheath,improve the rate of postoperative stone removal,reduce the occurrence rate of postoperative complications,so it has more significant advantages in terms of effectiveness and safety.