根治性膀胱切除术后患者肾功能损害发生率及影响因素的系统评价与Meta分析

Prevalence and Influence Factors of Renal Function Impairment in Patients Following Radical Cystectomy:A Systematic Review and Meta-analysis

目的系统评价根治性膀胱切除术患者术后肾功能损害的发生率及影响因素。方法检索维普、万方、中国知网、中国生物医学文献数据库、The Cochrane Library、PubMed、Web of Science和Embase数据库中与根治性膀胱切除术患者术后肾功能损害有关的队列研究与病例对照研究。检索时限为建库至2023年9月30日。由2名研究者按照纳入与排除标准独立进行文献筛选、文章质量评价并数据进行提取。采用Stata14.0软件对文献进行Meta分析。结果共纳入11篇文献,Meta分析显示,纳入研究的异质性较大(I^(2)=92.5%,P<0.001),基于随机效应模型得出根治性膀胱切除术后患者肾功能损害发生率为32%[95%CI(0.25,0.35),P<0.001],亚组分析显示,研究时长在5 a及其以上30%[95%CI(0.24,0.37),P<0.001]、研究地区为亚洲35%[95%CI(0.28,0.42),P<0.001]、以术后估计肾小球滤过率<45 mL/(min·1.73 m^(2))为评价肾功能损害的标准33%[95%CI(0.29,0.36),P<0.001]、队列研究39%[95%CI(0.26,0.52),P<0.001]肾功能损害发生率更高。术后发生肾功能损害的影响因素为年龄[HR=1.03,95%CI(1.02,1.04)]、高血压[HR=2.14,95%CI(1.32,3.40)]、肾积水[HR=1.89,95%CI(1.50,2.36)]、尿路感染[HR=1.35,95%CI(1.13,1.61)]和吻合口狭窄[HR=2.53,95%CI(1.77,3.61)]。结论根治性膀胱切除术后肾功能损害发生率较高,且与年龄、高血压病史、术后肾积水、尿路感染及吻合口狭窄密切相关,医护人员应加强对此类患者术后肾功能的监测,针对相关影响因素制定有效措施,以降低肾功能损害的发生率。

Objective To systematically evaluate the incidence and influencing factors of postoperative renal dysfunction in patients undergoing radical cystectomy.Methods The cohort studies and case-control studies related to postoperative renal function damage of patients undergoing radical cystectomy were retrieved from China HowNet,VIP,Wanfang,China Biomedical Literature Database,The Cochrane Library,PubMed,Web of Science and Embasedatabases.The retrieval time is from the establishment of the database to September 30,2023.Two researchers independently conducted literature screening and article quality assessment based on predefined inclusion and exclusion criteria.Mata analysis was carried out on the literature with Stata14.0 software.Results A total of 11 articles were included.Meta-analysis showed that the heterogeneity of the included studies was large(I^(2)=92.5%,P<0.001).Based on the random effect model,the incidence of renal function damage after radical cystectomy was 32%[95%CI(0.25,0.35),P<0.001],and subgroup analysis showed that the research duration was 5 years or more 30%[95%CI(0.24,0.37),P<0.001],the study area was Asia35%[95%CI(0.28,0.42)in Asia,P<0.001],the postoperative estimated glomerular filtration rate was<45 mL/(min·1.73m^(2))as the evaluation standard of renal function damage 33%[95%CI(0.29,0.36),P<0.001]and cohort studies 39%[95%CI(0.26,0.52),P<0.001]is higher.The influencing factors of postoperative renal dysfunction were age[HR=1.03,95%CI(1.02,1.04)],hypertension[HR=2.14,95%CI(1.32,3.40)],hydronephrosis[HR=1.89,95%CI(1.50,2.36)],urinary tract infection[HR=1.35,95%CI(1.13,1.61)]and Anastomotic stenosis[HR=2.53,95%CI(1.77,3.61)].Conclusion The incidence of renal function damage after radical cystectomy is high,which is closely related to age,history of hypertension,postoperative hydronephrosis,urinary tract infection and anastomotic stenosis.Medical staff should strengthen the monitoring of postoperative renal function and formulate effective measures for related influencing factors to reduce the incidence of renal function damage.