经皮肾镜取石术后D-J管与传统肾造瘘管引流效果的系统评价_《中国循证医学杂志》

作者：

刘勇 ¹ ,  王佳 ² , 魏强 ² , 沈朋飞 ¹ , 黄晓科 ¹

1. 四川大学华西临床医学院（成都 610041）；2. 四川大学华西医院泌尿外科（成都 610041）;

关键词：

肾结石经皮肾镜无管 D-J 管系统评价

DOI：

10.7507/1672-2531.20090045

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价D-J 管相对于传统肾造瘘管进行经皮肾镜取石术后引流的有效性与安全性。
方法　计算机检索PubMed（1966 ～ 2008.8）、EMbase（1966 ～ 2008.8）、Cochrane 临床对照试验资料库（2008 年第3 期）、中国生物医学文献数据库（1978 ～ 2008.8）、中文期刊全文数据库（1979 ～ 2008.8）和维普中刊数据库（1989 ～ 2008.8），纳入无管化经皮肾镜取石的随机与半随机对照试验，按Cochrane 系统评价方法评价纳入研究质量，并采用RevMan5.0.16 软件进行Meta 分析。
结果　共纳入8 个研究，包括507 例肾结石患者。根据肾造瘘管（有管组）直径分为小﹙8 ～ 9 Fr）、中﹙16 ～ 18 Fr﹚、大﹙20 ～ 24 Fr﹚ 孔三个亚组，结果显示：① 术后平均住院时间（h）：无管组与小孔组相比差异无统计学意义，无管组与中等孔组、大孔组相比差异有统计学意义［WMD（95%CI）分别为– 32.4（– 33.64，– 31.16）和– 39.07（– 67.75，– 10.39）］；② 术后漏尿：无管组与小孔组相比差异无统计学意义，无管组与中等孔组相比差异无统计学意义［RR= 0.07，95%CI（0.00，1.15），P=0.06］；③ 术后疼痛视觉模拟评分（VAS）：无管组与小孔组相比结果差异无统计学意义，无管组与中孔组和大孔组相比差异有统计学意义［MD（95%CI）分别为– 2.8（– 2.94，– 2.66）和– 2.04（– 2.29，– 1.79）］；④ 术后输血、发热（感染）、手术时间，无管组与有管组相比差异无统计学意义。
结论　基于目前所纳入的随机对照试验，经皮肾镜取石术后引流无管组（D-J）与小孔组各项指标比较差异无统计学意义；但无管组与中孔组和大孔组相比，无管组在住院时间、术后漏尿、术后疼痛方面更具优势，在术后并发症与手术时间方面则差异无统计学意义。由于本系统评价纳入研究数量少，且有存在选择偏倚、实施偏倚与发表偏倚的可能性，故应谨慎看待以上结论，期待更多高质量的随机对照试验提供更可靠的证据。

引用本文： 刘勇,王佳,魏强,沈朋飞,黄晓科. 经皮肾镜取石术后D-J管与传统肾造瘘管引流效果的系统评价. 中国循证医学杂志, 2009, 09(2): 230-238. doi: 10.7507/1672-2531.20090045 复制

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.

《中国循证医学杂志》

经皮肾镜取石术后D-J管与传统肾造瘘管引流效果的系统评价

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《中国循证医学杂志》

经皮肾镜取石术后D-J管与传统肾造瘘管引流效果的系统评价

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