經輸尿管鏡碎石術后雙Ｊ管留置必要性及安全性的系統評價_《中國循證醫學雜志》

作者：

茍江 ,  董強 , 鄧實 , 徐勇

四川大學華西醫院泌尿外科（成都 610041）;

關鍵詞：

輸尿管結石雙J管療效安全性隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20100550

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目的　系統評價經輸尿管鏡碎石術后雙Ｊ管留置的必要性及安全性。
方法　計算機檢索MEDLINE、EMbase、Cochrane圖書館、中國生物醫學文獻光盤數據、中文科技期刊全文數據庫、CNKI，納入經輸尿管碎石術后雙J管留置的隨機對照試驗（RCT）。檢索時間為2000年～2010年3月。對納入研究進行質量評價，提取有效數據，采用RevMan 5.0進行Meta分析。
結果　共納入6個RCT，涉及輸尿管鏡下碎石患者543例。Meta分析結果表明，單純性輸尿管結石患者經輸尿管鏡碎石術后：① 兩組術后患者結石清除率差異無統計學意義［RR=0.45，95%CI（0.98，1.01），P=0.15］；② 兩組術后患者排尿困難發生率差異無統計學意義［RR=1.35，95%CI（0.99，1.84），P=0.06］；③ 兩組術后患者血尿發生率差異無統計學意義［RR=2.12，95%CI（1.00，4.49），P=0.05］；④ 兩組術后患者尿頻發生率差異有統計學意義［RR=2.17，95%CI（1.13，4.17），P=0.02］；⑤ 兩組術后患者第三天軀體疼痛評分差異有統計學意義［WMD=0.94，95%CI（0.47，1.42），P=0.000?1］；⑥ 兩組患者手術時間差異有統計學意義［WMD=3.57，95%CI（1.40，5.72），P=0.001］。術后不予留置雙J管能明顯減少患者手術時間及術后因雙Ｊ管引起的膀胱刺激癥狀，提高患者術后生活質量，但并不影響術后結石的清除率。
結論　經輸尿管鏡碎石術后，常規留置雙Ｊ管可能不必要，且可減少留置導致的副作用。但由于納入試驗的方法學質量普遍較低，期待更多設計合理的大樣本隨機雙盲對照試驗提供高質量的證據。

引用本文： 茍江,董強,鄧實,徐勇. 經輸尿管鏡碎石術后雙Ｊ管留置必要性及安全性的系統評價. 中國循證醫學雜志, 2010, 10(9): 1096-1101. doi: 10.7507/1672-2531.20100550 復制

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2.	Devarajan R, Ashraf M, Beck RO, et al. Holmium:YAG lasertripsy for ureteral calculi: an experience of 300 procedures. Br J Urol, 1998, 82: 342.
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4.	Ryan PC, Lennon GM, Fitzpatrick JM. The effects of acute and chronic JJ stent placement on upper urinary tract, motility and calculus placement. Br J Urol, 1994, 71: 434.
5.	Bierkens AF, Hendrikx AJM, Lemmens WAJ, et al. Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial. J Urol, 1991, 145: 699.
6.	Hosking DH, McColm SE, Smith WE. Is stenting following ureteroscopy for removal of distal ureteral calculi, necessary? J Urol, 1999, 161: 48.
7.	Chenung Fl, Leung Yl, Wong Bb, et al. A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol, 2003, 169: 1257-1260.
8.	Xu Y, Wei Q, Liang RL. A prospective ran-domized trial comparing non-stented ver-sus routine stented ureteroscopic holmium laser lithotripsy. Saudi Med J, 2009, 30(10): 1276-1280.
9.	Yung Tc, Jun Chen, Wai Yw, et al. Is ureteral stengting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Urol, 2002, 167: 1977-1980.
10.	Yi S, Jian Z, Xiao WS, et al. Nonstented versus toutine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. Urol Res, 2008, 36: 259-263.
11.	Damiano R, Autorino R, Esposito C, et al. Stent positioning after ureteroscopy forurinary calculi:the question is still open. European Urology, 2004, 46: 381-388.
12.	徐誼朝, 褚靖, 郭澤雄, 等. 輸尿管鏡治療輸尿管下段結石后常規放置輸尿管支架的必要性研究. 廣東醫學, 2009, 28(9): 1389-1390.
13.	Djaladat H, Tajik P, Payandemehr P, et al. Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol, 2007, 52: 836-841.
14.	Joshi HB, Stainthorpe A, MacDonagh RP, et al. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol, 169: 1065-1069.
15.	Bierkens AF, Hendrikx AJM, Lemmens WAJ, et al. Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial. J Urol, 1991, 145: 699.

1. Young KH, Dong SP. Ureteroscopic Lithotripsy Using Swiss Lithoclast for Trearment of Ureteral Calculi:12-year Experience. J Korean Med Sci, 2009, 24(4): 690-694.
2. Devarajan R, Ashraf M, Beck RO, et al. Holmium:YAG lasertripsy for ureteral calculi: an experience of 300 procedures. Br J Urol, 1998, 82: 342.
3. Matsuoka K, Iida S, Nakanami M, et al. Holmium:yttrium-aluminum-garnet laser for endoscopic lithotripsy. Urology, 1995, 45: 947.
4. Ryan PC, Lennon GM, Fitzpatrick JM. The effects of acute and chronic JJ stent placement on upper urinary tract, motility and calculus placement. Br J Urol, 1994, 71: 434.
5. Bierkens AF, Hendrikx AJM, Lemmens WAJ, et al. Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial. J Urol, 1991, 145: 699.
6. Hosking DH, McColm SE, Smith WE. Is stenting following ureteroscopy for removal of distal ureteral calculi, necessary? J Urol, 1999, 161: 48.
7. Chenung Fl, Leung Yl, Wong Bb, et al. A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol, 2003, 169: 1257-1260.
8. Xu Y, Wei Q, Liang RL. A prospective ran-domized trial comparing non-stented ver-sus routine stented ureteroscopic holmium laser lithotripsy. Saudi Med J, 2009, 30(10): 1276-1280.
9. Yung Tc, Jun Chen, Wai Yw, et al. Is ureteral stengting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Urol, 2002, 167: 1977-1980.
10. Yi S, Jian Z, Xiao WS, et al. Nonstented versus toutine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. Urol Res, 2008, 36: 259-263.
11. Damiano R, Autorino R, Esposito C, et al. Stent positioning after ureteroscopy forurinary calculi:the question is still open. European Urology, 2004, 46: 381-388.
12. 徐誼朝, 褚靖, 郭澤雄, 等. 輸尿管鏡治療輸尿管下段結石后常規放置輸尿管支架的必要性研究. 廣東醫學, 2009, 28(9): 1389-1390.
13. Djaladat H, Tajik P, Payandemehr P, et al. Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol, 2007, 52: 836-841.
14. Joshi HB, Stainthorpe A, MacDonagh RP, et al. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol, 169: 1065-1069.
15. Bierkens AF, Hendrikx AJM, Lemmens WAJ, et al. Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial. J Urol, 1991, 145: 699.

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經輸尿管鏡碎石術后雙Ｊ管留置必要性及安全性的系統評價

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《中國循證醫學雜志》

經輸尿管鏡碎石術后雙Ｊ管留置必要性及安全性的系統評價

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