目的:评估输尿管损伤的发生率,预防性输尿管支架置入术的临床价值,以及术中或术后检测到妇科或结直肠手术患者输尿管损伤的影响。
方法:根据系统评价和荟萃分析的首选报告项目,在多个数据库中搜索2021年9月之前发表的文章。如果研究评估腹腔镜手术和开腹手术之间输尿管损伤率的差异,则认为研究合格。预防性输尿管支架置入术与否,以及接受妇科或结直肠手术的患者在术中和术后检测之间的最终治疗成功。
结果:总体而言,46项研究符合这项荟萃分析的条件。与开放手术相比,腹腔镜子宫切除术与较高的输尿管损伤发生率相关(合并比值比[OR];2.12,95%置信区间[CI];1.71-2.62),但结肠切除术无统计学差异(合并OR;0.89,95%CI;0.77-1.03).预防性输尿管支架置入术与妇科手术中输尿管损伤发生率较低相关(合并OR;0.61,95CI;0.39-0.96)。在妇科手术中,需要进行输尿管支架置入术以防止一次输尿管损伤的数量为224。另一方面,预防性输尿管支架置入术并不能降低结直肠手术中输尿管损伤的风险.与术后检测(合并OR;0.22,95CI;0.12-0.41)相比,术中检测到输尿管损伤与并发症管理失败的发生率较低相关。
结论:腹腔镜子宫切除术与开腹手术相比,输尿管损伤发生率更高。在妇科手术中,预防性输尿管支架置入术似乎可以降低这种风险。腹部/骨盆手术中输尿管损伤的术中检测可改善结果,表明需要意识和主动识别问题。需要进一步精心设计的研究,评估更有可能从预防性输尿管支架置入术中受益的候选人,包括成本分析。
To assess the incidence of ureteric injuries, clinical value of prophylactic ureteric stenting and impact of intra- or postoperative detection of ureteric injuries in patients treated with gynaecological or colorectal surgery.
Multiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteric injuries between laparoscopic and open surgery, prophylactic ureteric stenting or not, and those of final treatment success between intra- and postoperative detection in patients who underwent gynaecological or colorectal surgery.
Overall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteric injuries (pooled odds ratio [OR] 2.12, 95% confidence interval [CI] 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR 0.89, 95% CI 0.77-1.03). Prophylactic ureteric stenting was associated with a lower incidence of ureteric injuries during gynaecological surgery (pooled OR 0.61, 95% CI 0.39-0.96). The number needed to perform ureteric stenting to prevent one ureteric injury was 224 in gynaecological surgery. On the other hand, prophylactic ureteric stenting did not reduce the risk of ureteric injuries during colorectal surgery. Intraoperative detection of a ureteric injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR 0.22, 95% CI 0.12-0.41).
Laparoscopic hysterectomy seems to be associated with a higher rate of ureteric injuries compared to an open approach. Prophylactic ureteric stenting seems to reduce this risk during gynaecological surgery. Intraoperative detection of a ureteric injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteric stenting including cost analysis are needed.