目的:比较急诊体外冲击波碎石术(eESWL)和延迟体外冲击波碎石术(dESWL)治疗输尿管结石的临床疗效和安全性。
方法:Cochrane图书馆,PubMed,谷歌学者,我们从1992年1月1日至2022年9月30日检索了WebofScience,纳入了所有涉及eESWL和dESWL的输尿管结石对比研究.使用ReviewManager5.3软件进行统计分析。漏斗图用于评估发表偏倚。
结果:共纳入9篇文献,涉及976例输尿管结石患者。结果显示,eESWL组4周后结石清除率(SFR)明显高于dESWL组[相对危险度(RR)=1.22,95%可信区间(CI):1.13~1.32,P<0.01]。在不同石头位置的亚组分析中,eESWL组输尿管近端结石[RR=1.25,95%CI:1.14-1.38,P<0.01]和输尿管中段结石[RR=1.18,95%CI:1.03-1.34,P<0.05]均显示较高的SFR。eESWL显著缩短结石清除时间(SFT)[均差(MD)=-5.75,95%CI:-9.33~-2.17,P<0.01]。此外,eESWL显著降低辅助程序[RR=0.53,95%CI:0.40-0.70,P<0.01]。两组并发症比较差异无统计学意义[RR=0.90,95%CI:0.69~1.16,P>0.05]。
结论:eESWL能显著提高SFR,缩短SFT,减少辅助程序。
OBJECTIVE: To compare the clinical efficiency and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of ureteral stones.
METHODS: Cochrane Library, PubMed, Google Scholar, and Web of Science were searched from January 1, 1992 to September 30, 2022, and all comparative studies involving eESWL and dESWL for ureteral calculi were included. Statistical analysis was performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias.
RESULTS: A total of 9 articles involving 976 patients diagnosed with ureteral stones were included. The results showed that the stone-free rate (SFR) after four weeks was significantly higher in the eESWL group than in the dESWL group [relative risk (RR) = 1.22, 95% confidence interval (CI): 1.13-1.32, P < 0.01]. In subgroup analysis of different stone locations, proximal ureteral calculi [RR = 1.25, 95% CI: 1.14-1.38, P < 0.01] and mid-to-distal ureteral calculi [RR = 1.18, 95% CI: 1.03-1.34, P < 0.05] all showed a higher SFR in the eESWL group. eESWL significantly shortened the stone-free time(SFT) [mean difference (MD) = -5.75, 95% CI: -9.33 to -2.17, P < 0.01]. In addition, eESWL significantly reduced auxiliary procedures [RR = 0.53, 95% CI: 0.40-0.70, P < 0.01]. No significant difference in complications was found between the two groups [RR = 0.90, 95% CI: 0.69-1.16, P > 0.05].
CONCLUSIONS: eESWL can significantly improve SFR, shorten SFT, and reduce auxiliary procedures.