门诊妇科手术后逆行性膀胱充盈：系统评价和荟萃分析。
Retrograde Bladder Filling After Outpatient Gynecologic Surgery: A Systematic Review and Meta-analysis.
机构信息
Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, the Department of Obstetrics and Gynecology, Mount Sinai Hospital, and the Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, the Department of Obstetrics and Gynaecology, McGill University Health Centre, McGill University, Montreal, Québec, and the Biostatistics Research Unit, University Health Network, and Library Services, Mount Sinai Hospital, Toronto, Ontario, Canada.
出版信息
Obstet Gynecol. 2021 Oct 1;138(4):647-654. doi: 10.1097/AOG.0000000000004541.
OBJECTIVE
To systematically review and meta-analyze randomized controlled trials (RCTs) comparing postoperative bladder retrofilling to passive filling after outpatient gynecologic surgery to evaluate effects on postoperative outcomes.
DATA SOURCES
We searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and ClinicalTrials.gov from 1947 to August 2020.
METHODS OF STUDY SELECTION
Two reviewers screened 1,465 articles. We included RCTs that compared postoperative bladder retrofilling to passive filling in patients who underwent outpatient gynecologic surgery by any approach. The primary outcome was the time to first void. Secondary outcomes included time to discharge, postoperative urinary retention, urinary tract infection, and patient satisfaction. Mean differences and relative risks (RRs) were calculated for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias Tool.
TABULATION, INTEGRATION, AND RESULTS: We included eight studies with 1,173 patients. Bladder retrofilling in the operating room resulted in a significant decrease in the time to first void (mean difference -33.5 minutes; 95% CI -49.1 to -17.9, 4 studies, 403 patients) and time to discharge (mean difference -32.0 minutes; 95% CI -51.5 to -12.6, eight studies, 1,164 patients). Bladder retrofilling did not shorten time to discharge when performed in the postanesthetic care unit (mean difference -14.8 min; 95% CI -62.6 to 32.9, three studies, 258 patients) or after laparoscopic hysterectomy (mean difference -26.0 min; 95% CI -56.5 to 4.5, five studies, 657 patients). There were no differences in postoperative urinary retention (RR 0.77; 95% CI 0.45-1.30, five studies, 910 patients) or risk of urinary tract infection between the retrofill and passive fill groups (RR 0.50; 95% CI 0.14-1.77, four studies, 387 patients). Patient satisfaction was comparable between groups.
CONCLUSION
Retrofilling the bladder in the operating room after outpatient gynecologic surgery modestly reduces the time to first void and discharge with no increase in adverse events.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020203692.
目的
系统评价和荟萃分析比较门诊妇科手术后膀胱逆行充盈与被动充盈的随机对照试验（RCT），以评估对术后结果的影响。
数据来源
我们检索了 1947 年至 2020 年 8 月的 MEDLINE、PubMed、Cochrane 对照试验中心注册库（CENTRAL）、EMBASE 和 ClinicalTrials.gov。
研究选择方法
两名审查员筛选了 1465 篇文章。我们纳入了通过任何方法在门诊妇科手术后比较膀胱逆行充盈与被动充盈的 RCT。主要结局是首次排尿时间。次要结局包括出院时间、术后尿潴留、尿路感染和患者满意度。对荟萃分析计算了均数差和相对风险（RR）。使用 Cochrane 偏倚风险工具评估偏倚风险。
表格化、综合和结果：我们纳入了 8 项研究，共 1173 名患者。手术室中进行膀胱逆行充盈可显著缩短首次排尿时间（平均差-33.5 分钟；95%CI-49.1 至-17.9，4 项研究，403 名患者）和出院时间（平均差-32.0 分钟；95%CI-51.5 至-12.6，8 项研究，1164 名患者）。在麻醉后护理单元（平均差-14.8 分钟；95%CI-62.6 至 32.9，3 项研究，258 名患者）或腹腔镜子宫切除术后（平均差-26.0 分钟；95%CI-56.5 至 4.5，5 项研究，657 名患者）进行膀胱逆行充盈并未缩短出院时间。两组间术后尿潴留（RR 0.77；95%CI 0.45-1.30，5 项研究，910 名患者）或尿路感染风险（RR 0.50；95%CI 0.14-1.77，4 项研究，387 名患者）均无差异。两组患者满意度相当。
结论
门诊妇科手术后在手术室中对膀胱进行逆行充盈可适度缩短首次排尿和出院时间，且无不良事件增加。
系统评价注册
PROSPERO，CRD42020203692。
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