經皮腎鏡取石術后D-J管與傳統腎造瘺管引流效果的系統評價_《中國循證醫學雜志》

作者：

劉勇 ¹ ,  王佳 ² , 魏強 ² , 沈朋飛 ¹ , 黃曉科 ¹

1. 四川大學華西臨床醫學院（成都 610041）；2. 四川大學華西醫院泌尿外科（成都 610041）;

關鍵詞：

腎結石經皮腎鏡無管 D-J 管系統評價

DOI：

10.7507/1672-2531.20090045

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目的　系統評價D-J 管相對于傳統腎造瘺管進行經皮腎鏡取石術后引流的有效性與安全性。
方法　計算機檢索PubMed（1966 ～ 2008.8）、EMbase（1966 ～ 2008.8）、Cochrane 臨床對照試驗資料庫（2008 年第3 期）、中國生物醫學文獻數據庫（1978 ～ 2008.8）、中文期刊全文數據庫（1979 ～ 2008.8）和維普中刊數據庫（1989 ～ 2008.8），納入無管化經皮腎鏡取石的隨機與半隨機對照試驗，按Cochrane 系統評價方法評價納入研究質量，并采用RevMan5.0.16 軟件進行Meta 分析。
結果　共納入8 個研究，包括507 例腎結石患者。根據腎造瘺管（有管組）直徑分為小﹙8 ～ 9 Fr）、中﹙16 ～ 18 Fr﹚、大﹙20 ～ 24 Fr﹚ 孔三個亞組，結果顯示：① 術后平均住院時間（h）：無管組與小孔組相比差異無統計學意義，無管組與中等孔組、大孔組相比差異有統計學意義［WMD（95%CI）分別為– 32.4（– 33.64，– 31.16）和– 39.07（– 67.75，– 10.39）］；② 術后漏尿：無管組與小孔組相比差異無統計學意義，無管組與中等孔組相比差異無統計學意義［RR= 0.07，95%CI（0.00，1.15），P=0.06］；③ 術后疼痛視覺模擬評分（VAS）：無管組與小孔組相比結果差異無統計學意義，無管組與中孔組和大孔組相比差異有統計學意義［MD（95%CI）分別為– 2.8（– 2.94，– 2.66）和– 2.04（– 2.29，– 1.79）］；④ 術后輸血、發熱（感染）、手術時間，無管組與有管組相比差異無統計學意義。
結論　基于目前所納入的隨機對照試驗，經皮腎鏡取石術后引流無管組（D-J）與小孔組各項指標比較差異無統計學意義；但無管組與中孔組和大孔組相比，無管組在住院時間、術后漏尿、術后疼痛方面更具優勢，在術后并發癥與手術時間方面則差異無統計學意義。由于本系統評價納入研究數量少，且有存在選擇偏倚、實施偏倚與發表偏倚的可能性，故應謹慎看待以上結論，期待更多高質量的隨機對照試驗提供更可靠的證據。

引用本文： 劉勇,王佳,魏強,沈朋飛,黃曉科. 經皮腎鏡取石術后D-J管與傳統腎造瘺管引流效果的系統評價. 中國循證醫學雜志, 2009, 09(2): 230-238. doi: 10.7507/1672-2531.20090045 復制

1.	Wickham JE, Miller RA, Kellett MJ, et al. Percutaneous nephrolithotomy: One stage or two? Br J Urol, 1984, 56: 582-585.
2.	Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: Complications of premature nephrostomy tube removal. J Urol, 1986, 136: 77-79.
3.	Bellman GC, Davidoff R, Candela J, et al. Tubeless per-cutaneous renal surgery. J Urol, 1997, 157: 1578-1582.
4.	Pietrow PK, Auge BK, Lallas CD. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol, 2003, 17(6): 411-414.
5.	Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol, 2000, 14(9): 735-737.
6.	Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]. The Cochrane Library, Issue 4, 2006. Chichester, UK: JohnWiley & sons, Ltd.
7.	Desai MR, Kukreja RA, Desai MM, et al. A prospective randomized compar i son of type of nephros tomy drainage fol lowing percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol, 2004, 172 (2): 565-567.
8.	Feng MI, Tamaddon K, Mikhail A, et al. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology, 2001, 58(3): 345-350.
9.	Choi M, Brusky J, Weaver J, et al. Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube. J Endourol, 2006, 20(10): 766-770.
10.	Sofikerim M, Demirci D, Huri E, et al. Tubeless percutaneous nephrolithotomy: safe even in supracostal access. J Endourol, 2007, 21(9): 967-972.
11.	Marcovich R, Jacobson AI, Singh J, et al. No panacea for drainage after percutaneous nephrolithotomy. J Endourol, 2004, 18(8): 743-747.
12.	Agrawal MS, Agrawal M, Gupta A, et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol, 2008, 22(3): 439-442.
13.	Shah HN, Sodha HS, Khandkar AA, et al. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol, 2008, 22(7): 1433-1439.
14.	Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid? J Endourol, 2008 , 22(3): 427-434.
15.	Gupta NP, Kesarwani P, Goel R, et al. Tubeless percutaneous nephrolithotomy. A comparative study with standard percutaneous nephrolithotomy. Urol Int, 2005, 74(1): 58-61.
16.	Al-Ba’adani TH, Al-Kohlany KM, Al-Adimi A, et al. Tubeless percutaneous neprolithotomy: the new gold standard. Int Urol Nephrol, 2008, 40(3): 603-608.
17.	Abou-Elela A, Emran A, Mohsen MA, et al. Safety and efficacy of tubeless percutaneous renal surgery. Int Urol Nephrol, 2008, 40(3): 603-608.
18.	Crook TJ, Lockyer CR, Keoghane SR, et al. Totally tubeless percutaneous nephrolithotomy. J Endourol, 2008, 22(2): 267-271.
19.	Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J Endourol, 2004, 18(7): 647-648.
20.	Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol, 2004, 18(5): 475-476.
21.	Zaman ZR, Kommu SS, Watkin NA, et al. Tubeless percutaneous nephrolithotomy in the management of renal calculi. BAUS abstracts P032. BJU Int, 2006, 97: 43.
22.	Aghamir SM, Khazaeli MH, Meisami A. Use of Surgicel for sealing nephrostomy tract after totally tubeless percutaneous nephrolithotomy. J Endourol, 2006, 20(5): 293-295.
23.	Yu DS. Gelatin packing of intracortical tract after percutaneous nephrostomy lithotripsy for decreasing bleeding and urine leakage. J Chin Med Assoc, 2006, 69(4): 162-165.
24.	Le e DI , Ur ibe C, Ei che l L, e t al . Seal ing pe r cutaneous nephrolithotomy tracts with gelatin matrix hemostatic sealant: initial clinical use. J Urol, 2004, 171(2 Pt 1): 575-578.

1. Wickham JE, Miller RA, Kellett MJ, et al. Percutaneous nephrolithotomy: One stage or two? Br J Urol, 1984, 56: 582-585.
2. Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: Complications of premature nephrostomy tube removal. J Urol, 1986, 136: 77-79.
3. Bellman GC, Davidoff R, Candela J, et al. Tubeless per-cutaneous renal surgery. J Urol, 1997, 157: 1578-1582.
4. Pietrow PK, Auge BK, Lallas CD. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol, 2003, 17(6): 411-414.
5. Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol, 2000, 14(9): 735-737.
6. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]. The Cochrane Library, Issue 4, 2006. Chichester, UK: JohnWiley & sons, Ltd.
7. Desai MR, Kukreja RA, Desai MM, et al. A prospective randomized compar i son of type of nephros tomy drainage fol lowing percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol, 2004, 172 (2): 565-567.
8. Feng MI, Tamaddon K, Mikhail A, et al. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology, 2001, 58(3): 345-350.
9. Choi M, Brusky J, Weaver J, et al. Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube. J Endourol, 2006, 20(10): 766-770.
10. Sofikerim M, Demirci D, Huri E, et al. Tubeless percutaneous nephrolithotomy: safe even in supracostal access. J Endourol, 2007, 21(9): 967-972.
11. Marcovich R, Jacobson AI, Singh J, et al. No panacea for drainage after percutaneous nephrolithotomy. J Endourol, 2004, 18(8): 743-747.
12. Agrawal MS, Agrawal M, Gupta A, et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol, 2008, 22(3): 439-442.
13. Shah HN, Sodha HS, Khandkar AA, et al. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol, 2008, 22(7): 1433-1439.
14. Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid? J Endourol, 2008 , 22(3): 427-434.
15. Gupta NP, Kesarwani P, Goel R, et al. Tubeless percutaneous nephrolithotomy. A comparative study with standard percutaneous nephrolithotomy. Urol Int, 2005, 74(1): 58-61.
16. Al-Ba’adani TH, Al-Kohlany KM, Al-Adimi A, et al. Tubeless percutaneous neprolithotomy: the new gold standard. Int Urol Nephrol, 2008, 40(3): 603-608.
17. Abou-Elela A, Emran A, Mohsen MA, et al. Safety and efficacy of tubeless percutaneous renal surgery. Int Urol Nephrol, 2008, 40(3): 603-608.
18. Crook TJ, Lockyer CR, Keoghane SR, et al. Totally tubeless percutaneous nephrolithotomy. J Endourol, 2008, 22(2): 267-271.
19. Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J Endourol, 2004, 18(7): 647-648.
20. Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol, 2004, 18(5): 475-476.
21. Zaman ZR, Kommu SS, Watkin NA, et al. Tubeless percutaneous nephrolithotomy in the management of renal calculi. BAUS abstracts P032. BJU Int, 2006, 97: 43.
22. Aghamir SM, Khazaeli MH, Meisami A. Use of Surgicel for sealing nephrostomy tract after totally tubeless percutaneous nephrolithotomy. J Endourol, 2006, 20(5): 293-295.
23. Yu DS. Gelatin packing of intracortical tract after percutaneous nephrostomy lithotripsy for decreasing bleeding and urine leakage. J Chin Med Assoc, 2006, 69(4): 162-165.
24. Le e DI , Ur ibe C, Ei che l L, e t al . Seal ing pe r cutaneous nephrolithotomy tracts with gelatin matrix hemostatic sealant: initial clinical use. J Urol, 2004, 171(2 Pt 1): 575-578.

《中國循證醫學雜志》

經皮腎鏡取石術后D-J管與傳統腎造瘺管引流效果的系統評價

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《中國循證醫學雜志》

經皮腎鏡取石術后D-J管與傳統腎造瘺管引流效果的系統評價

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