體外沖擊波碎石術前置入輸尿管支架治療輸尿管結石價值的系統評價_《中國循證醫學雜志》

作者：

 邵永勝 , 黃祥

雅安市第二人民醫院（四川雅安 625000）;

關鍵詞：

體外沖擊波碎石輸尿管支架輸尿管結石隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20100586

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目的　系統評價體外沖擊波碎石術（ESWL）前置入輸尿管支架的價值。
方法　計算機檢索Cochrane圖書館臨床對照試驗注冊中心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），手工檢索相關文獻，納入在ESWL前置入輸尿管支架治療輸尿管結石的隨機對照試驗（RCT）。按Cochrane評價員手冊5.0.1版評估納入研究的偏倚風險，并用RevMan5.0軟件進行統計分析。
結果　共納入3個RCT，共319例輸尿管結石患者。其研究質量均為C級。Meta分析結果顯示：① 療效指標：ESWL前置入輸尿管支架在結石完全清除率、碎石次數、碎石沖擊波頻率、碎石沖擊波能量方面并未表現出較好的療效，其WMD（95%CI）分別為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 術后并發癥發生率：ESWL前置入輸尿管支架術后較易發生排尿困難、鏡下血尿、肉眼血尿、膿尿、尿培養陽性、恥骨上疼痛，其RR（95%CI）分別為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），且無助于預防石街形成［RR=0.39，95%CI（0.03，4.58）］。
結論　現有證據表明，ESWL前置入輸尿管支架的方法不可取。因納入研究質量不高且例數較少，上述結論尚期待更多高質量的試驗加以驗證。

引用本文： 邵永勝,黃祥. 體外沖擊波碎石術前置入輸尿管支架治療輸尿管結石價值的系統評價. 中國循證醫學雜志, 2010, 10(11): 1293-1301. doi: 10.7507/1672-2531.20100586 復制

1.	Chaussy CH, Brendel W, Schmiedt. Extracorporeally induced destruction of kidney stones by shock waves. The Lancet, 1980, 316(8207): 1265-1268.
2.	Gomha MA, Sheir KZ, Showky S, et al. Can we inprove the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or statistical model? The Journal of Urology, 2004, 172: 175-179.
3.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009, Available from: www.cochrane-handbook.org.
4.	EI-Assmy A, EI-Nahas AR, Sheir KZ. Is Pre-Shock Wave Lithotripsy Stenting Necessary for Ureteral Stones With Moderate or Severe Hydronephrosis? The Journal of Urology, 2006, 176: 2059-2062.
5.	Ghoneim IA, EI-Ghoneimy MN, EI- Naggar AE, et al. Extracorporeal Shock Wave Lithotripsy in Impacted Upper Ureteral Stones: A Prospective Randomized Comparison Between Stented and Non-stented Techniques. Urology, 2010, 75: 45-50.
6.	虎華靜, 鄧發凱, 吳建軍, 等. 雙“J”管在體外沖擊波碎石治療輸尿管結石中的應用. 現代預防醫學, 2007, 34(7): 1384-1385.
7.	那彥群, 郭震華. 實用泌尿外科學. 第1版. 北京: 人民衛生出版社, 2009: 243-247.
8.	Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. The Journal of Urology, 1999, 143: 263-266.
9.	Cass AS. Do upper ureteral stones need to be manipulated into the kidney before extracorporeal shock wave lithotripsy. The Journal of Urology, 1992, 147: 349-351.
10.	Al-Awadi KA, Abdul Halim H, Kehinde EO, et al. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU International, 1999, 84(6): 618-621.
11.	Argyropoulos AN, Tolley DA. Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysis. BJU International, 2008, 103: 76-80.
12.	Chandhoke PS, Barqawi AZ, Wernecke C, et al. A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. The Journal of Urology, 2002, 167: 1981-1983.
13.	Hendrikx AJM, Bierkens AF, Oosterhof GON, et al. Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy. Journal of Endourology, 1990, 4(4):353-359.
14.	Mokhmalji H, Braun PM, Portillo FJ, et al. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones:a prospective, randomized clinical trial. The Journal of Urology, 2000, 165: 1088-1092.
15.	Haleblian G, Kijvikai K, Rosette JDL, et al. Ureteral Stenting and Urinary Stone Management: A Systematic Review. The Journal of Urology, 2008, 179: 424-430.
16.	Joshi HB, Newns N, Stainthorpe A, et al. Ureteral stent symptom questionnaire development and validation of a multidimensional quality of life measure. The Journal of Urology, 2003, 169: 1060-1064.

1. Chaussy CH, Brendel W, Schmiedt. Extracorporeally induced destruction of kidney stones by shock waves. The Lancet, 1980, 316(8207): 1265-1268.
2. Gomha MA, Sheir KZ, Showky S, et al. Can we inprove the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or statistical model? The Journal of Urology, 2004, 172: 175-179.
3. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009, Available from: www.cochrane-handbook.org.
4. EI-Assmy A, EI-Nahas AR, Sheir KZ. Is Pre-Shock Wave Lithotripsy Stenting Necessary for Ureteral Stones With Moderate or Severe Hydronephrosis? The Journal of Urology, 2006, 176: 2059-2062.
5. Ghoneim IA, EI-Ghoneimy MN, EI- Naggar AE, et al. Extracorporeal Shock Wave Lithotripsy in Impacted Upper Ureteral Stones: A Prospective Randomized Comparison Between Stented and Non-stented Techniques. Urology, 2010, 75: 45-50.
6. 虎華靜, 鄧發凱, 吳建軍, 等. 雙“J”管在體外沖擊波碎石治療輸尿管結石中的應用. 現代預防醫學, 2007, 34(7): 1384-1385.
7. 那彥群, 郭震華. 實用泌尿外科學. 第1版. 北京: 人民衛生出版社, 2009: 243-247.
8. Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. The Journal of Urology, 1999, 143: 263-266.
9. Cass AS. Do upper ureteral stones need to be manipulated into the kidney before extracorporeal shock wave lithotripsy. The Journal of Urology, 1992, 147: 349-351.
10. Al-Awadi KA, Abdul Halim H, Kehinde EO, et al. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU International, 1999, 84(6): 618-621.
11. Argyropoulos AN, Tolley DA. Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysis. BJU International, 2008, 103: 76-80.
12. Chandhoke PS, Barqawi AZ, Wernecke C, et al. A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. The Journal of Urology, 2002, 167: 1981-1983.
13. Hendrikx AJM, Bierkens AF, Oosterhof GON, et al. Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy. Journal of Endourology, 1990, 4(4):353-359.
14. Mokhmalji H, Braun PM, Portillo FJ, et al. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones:a prospective, randomized clinical trial. The Journal of Urology, 2000, 165: 1088-1092.
15. Haleblian G, Kijvikai K, Rosette JDL, et al. Ureteral Stenting and Urinary Stone Management: A Systematic Review. The Journal of Urology, 2008, 179: 424-430.
16. Joshi HB, Newns N, Stainthorpe A, et al. Ureteral stent symptom questionnaire development and validation of a multidimensional quality of life measure. The Journal of Urology, 2003, 169: 1060-1064.

《中國循證醫學雜志》

體外沖擊波碎石術前置入輸尿管支架治療輸尿管結石價值的系統評價

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《中國循證醫學雜志》

體外沖擊波碎石術前置入輸尿管支架治療輸尿管結石價值的系統評價

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