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目的系统评价体外冲击波碎石术(ESWL)前置入输尿管支架的价值。方法计算机检索Cochrane图书馆临床对照试验注册中心CCTR(2010.4)、MEDLINE(OVID,1950～2010.4)、EMbase(1966～2010.4)、CBM(1978～2010.4)、CNKI(1979～2010.4)和VIP(1989～2010.4),手工检索相关文献,纳入在ESWL前置入输尿管支架治疗输尿管结石的随机对照试验(RCT)。按Cochrane评价员手册5.0.1版评估纳入研究的偏倚风险,并用RevMan5.0软件进行统计分析。结果共纳入3个RCT,共319例输尿管结石患者。其研究质量均为C级。Meta分析结果显示:①疗效指标:ESWL前置入输尿管支架在结石完全清除率、碎石次数、碎石冲击波频率、碎石冲击波能量方面并未表现出较好的疗效,其WMD(95%CI)分别为1.10(0.87,1.38)、0.43(–1.05,0.19)、0.00(–0.25,0.25)、0.20(–0.05,0.46)。②术后并发症发生率:ESWL前置入输尿管支架术后较易发生排尿困难、镜下血尿、肉眼血尿、脓尿、尿培养阳性、耻骨上疼痛,其RR(95%CI)分别为2.30(1.62,3.26)、2.66(1.97,3.58)、6.50(1.50,28.15)、1.78(1.44,2.21)、2.13(1.71,2.64)和3.10(1.59,6.04),且无助于预防石街形成[RR=0.39,95%C(I0.03,4.58)]。结论现有证据表明,ESWL前置入输尿管支架的方法不可取。因纳入研究质量不高且例数较少,上述结论尚期待更多高质量的试验加以验证。
Objective To systematically evaluate the value of ESWL insertion into ureteral stents. Methods Cochrane Library CCTR (2010.4), MEDLINE (2005 ~ 2010.4), EMbase (1966-2010.4), CBM (1978-2010.4), CNKI (1979-2010.4) and VIP 2010.4), manual search of relevant literature to include randomized controlled trials (RCTs) of ureteral calculi placed before ESWL. The risks of bias included in the study were assessed according to the Cochrane Review Manual 5.0.1 and statistically analyzed using RevMan 5.0 software. Results A total of 3 RCTs were enrolled, a total of 319 cases of ureteral calculi. The quality of their research are C-level. The results of Meta analysis showed that: (1) Efficacy indicators: The ESWL anterior ureteral stent did not show a good curative effect in the complete stone clearance rate, the number of gravel, the frequency of the stone shock wave and the shock wave energy of the stone. The WMD (95% CI ) Were 1.10 (0.87, 1.38), 0.43 (-1.05, 0.19), 0.00 (-0.25, 0.25), 0.20 (-0.05, 0.46), respectively. ② The incidence of postoperative complications: dysuria was more likely to occur after ESWL insertion into the ureteral stents, with microscopic hematuria, gross hematuria, pyuria, urine culture positive and suprapubic pain with RR (95% CI) of 2.30 1.66, 2.66 (1.97, 3.58), 6.50 (1.50, 28.15), 1.78 (1.44, 2.21), 2.13 (1.71, 2.64) and 3.10 (1.59, 6.04) = 0.39, 95% C (I0.03, 4.58)]. Conclusion The available evidence shows that the pre-ESWL placement of ureteral stents is not desirable. Due to the poor quality of the included studies and the small number of cases, the conclusion above is still expected to be verified by more high-quality tests.