Picozzi Stefano C M, Ricci Cristian, Gaeta Maddalena, Casellato Stefano, Stubinski Robert, Bozzini Giorgio, Pace Gianna, Macchi Alberto, Carmignani Luca
Urology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, MI, Italy.
Urol Res. 2012 Oct;40(5):581-6. doi: 10.1007/s00240-012-0469-z. Epub 2012 Feb 25.
There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.
近期有多项关于输尿管镜使用的研究，且对于它是否应作为输尿管结石患者的一线治疗方法存在争议。本荟萃分析的目的是了解这种外科手术在急诊情况下作为一线治疗的作用，并在结石清除率和并发症方面比较即刻手术与延迟手术。我们在PubMed、MEDLINE和EMBASE数据库中进行了文献检索，检索时间跨度为1980年1月至2010年3月。本分析基于6项符合预先设定纳入标准的研究。共纳入681名参与者。各纳入研究的参与者数量从27名至244名不等（平均113名）。根据逻辑回归分析，近端输尿管结石清除率为81.9%（72.0 - 91.8），中段输尿管为87.3%（82.6 - 92.0），远端输尿管为94.9%（92.1 - 97.6），总体结石清除率为89.5%（86.5 - 92.5）。这些数值与美国泌尿外科学会（AUA）和欧洲泌尿外科学会（EAU）指南中报告的数值无统计学显著差异。结石直径似乎会影响结石清除率。对于远端和近端输尿管，结石直径超过8毫米每增加1毫米，结石清除率分别降低5%（2.4 - 8.0）和8.1%（3.8 - 12.1）。国际指南中完全缺乏关于急诊情况下输尿管结石的输尿管镜治疗的信息；目前可得的结果分散在文献中的少数研究中。采用急诊输尿管镜的基本原理是更快地清除结石并缓解绞痛。根据我们的荟萃分析，对于输尿管结石绞痛进行即刻输尿管镜检查似乎是一种成功率高的安全治疗方法。这一证据将通过纳入更多患者的进一步随机研究来验证。
