Department of Urology Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Ann Palliat Med. 2021 Oct;10(10):10527-10534. doi: 10.21037/apm-21-2228.
Laparoscopic pyeloplasty (LP) has been widely used to treat ureteropelvic junction obstruction (UPJO); however, no previous series of reports has focused on analyzing the factors that influence the complications and outcomes of LP. In this study, we analyzed the risk factors related to complications of LP, especially that of restenosis. The aim of this study is to perform meta-analysis of relevant comparative studies to analyze the risk factors of restenosis after LP treatment with ureteral stent as of 30 April 2021.
A systematic search was conducted in April 2021. The evaluation results included operation time (OT), intraoperative blood loss (IBL), anastomotic tension (AT), postoperative drainage (PD), and ectopic blood vessels (EBV). Relative risk (RR) and standardized mean difference (SMD) were extrapolated with a 95% confidence interval (CI). Subgroup analysis was performed based on research design and technology.
After screening, 7 studies were included, incorporating a total of 979 patients with PUJO treated by LP. Analysis revealed the likelihood of risk factors as follows: OT [mean difference (MD) -3.16, 95% CI: -7.18 to 0.85; P=0.12], IBL (MD -3.16, 95% CI: -7.18 to 0.85; P=0.12), AT (RR 3.86, 95% CI: 2.96 to 5.02; P<0.00001), PD (MD 303.97, 95% CI: 219.49 to 388.44; P<0.00001), and EBV (RR 1.15, 95% CI: 0.78 to 1.68; P=0.49). The results indicated that high AT and increased PD are risk factors for postoperative ureteral restenosis.
The results of the meta-analysis showed that among the factors related to the efficacy of LP in the treatment of ureteral stenosis, OT, IBL, AT, and EBV were not significantly correlated with postoperative restenosis. However, AT and PD are independent risk factors for postoperative restenosis of the ureter. Therefore, during the operation, the AT should be reduced, and the local injury is reduced to reduce the PD, thereby reducing the risk of restenosis.
腹腔镜肾盂成形术（LP）已广泛用于治疗肾盂输尿管连接部梗阻（UPJO）；然而，以前没有任何一系列的报告专门分析影响 LP 并发症和结果的因素。在这项研究中，我们分析了与 LP 并发症相关的危险因素，特别是再狭窄的危险因素。本研究的目的是对截止到 2021 年 4 月 30 日的 LP 治疗后使用输尿管支架治疗再狭窄的相关对照研究进行荟萃分析。
系统检索于 2021 年 4 月进行。评估结果包括手术时间（OT）、术中出血量（IBL）、吻合张力（AT）、术后引流（PD）和异位血管（EBV）。采用 95%置信区间（CI）推断相对风险（RR）和标准化均数差（SMD）。根据研究设计和技术进行亚组分析。
经过筛选，纳入了 7 项研究，共纳入 979 例 UPJO 患者行 LP 治疗。分析结果显示，存在以下风险因素的可能性如下：OT[平均差异（MD）-3.16，95%CI：-7.18 至 0.85；P=0.12]、IBL（MD-3.16，95%CI：-7.18 至 0.85；P=0.12）、AT（RR 3.86，95%CI：2.96 至 5.02；P<0.00001）、PD（MD 303.97，95%CI：219.49 至 388.44；P<0.00001）和 EBV（RR 1.15，95%CI：0.78 至 1.68；P=0.49）。结果表明，高 AT 和增加 PD 是术后输尿管再狭窄的危险因素。
荟萃分析结果表明，在与 LP 治疗输尿管狭窄疗效相关的因素中，OT、IBL、AT 和 EBV 与术后再狭窄无显著相关性。然而，AT 和 PD 是术后输尿管再狭窄的独立危险因素。因此，在手术过程中，应降低 AT，减少局部损伤，降低 PD，从而降低再狭窄的风险。
