输尿管镜检查在肥胖和病态肥胖患者中同样有效且安全：一项系统评价和荟萃分析
Ureteroscopy Is Equally Efficient and Safe in Obese and Morbidly Obese Patients: A Systematic Review and Meta-Analysis.
作者信息
Wang Wei, Gao XiaoShuai, Peng Liao, Jin Tao
机构信息
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Front Surg. 2022 Feb 18;9:736641. doi: 10.3389/fsurg.2022.736641. eCollection 2022.
BACKGROUND
Ureteroscopy (URS) has been established as an effective treatment for stones in obese patients (OP). However, recent studies found that the efficacy of the procedure may be lower in patients with higher body mass index (BMI). In the current study, we aim to determine if obesity might influence the effectiveness and safety of URS.
METHODS
In May 2021, a comprehensive search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to find eligible studies. Stone-free rate (SFR), operative time, length of stay, and complication rate were assessed utilizing RevMan 5.3.
RESULTS
Thirteen studies involving 4,583 normal-weight patients (NWP), 2,465 OP, and 291 morbidly OP (MOP) were included. Pooled results showed that statistically similar SFR existed between OP and NWP [odds ratio (): 1.09; 95% : 0.79, 1.52; = 0.59], and between MOP and NWP (: 1.03; 95% : 0.46, 2.31; = 0.95). The operation time was similar between OP and NWP [mean difference (): -2.27; 95% : -8.98, 4.43; = 0.51], and between MOP and NWP (: 4.85; 95% : -5.78, 15.47; = 0.37). In addition, no significant difference regarding length of stay existed between OP and NWP (: -0.07; 95% : -0.20, 0.07; = 0.33), and between MOP and NWP (: -0.06; 95% : -0.25, 0.14; = 0.58). Furthermore, we observed similar minor complication rate between OP and NWP (: 1.04; 95% : 0.81, 1.32; = 0.78), and between MOP and NWP (: 1.29; 95% : 0.80, 2.08; = 0.30). The differences concerning major complication rate between OP and NWP (: 0.97; 95% : 0.39, 2.43; = 0.95), and between MOP and NWP (: 2.01; 95% : 0.55, 7.30; = 0.29) were also not significant.
CONCLUSIONS
Our study demonstrated that URS performed in MOP and OP appears to have the same efficacy and safety as well as in NWP group.
背景
输尿管镜检查（URS）已被确立为肥胖患者（OP）结石的有效治疗方法。然而，最近的研究发现，该手术在体重指数（BMI）较高的患者中疗效可能较低。在本研究中，我们旨在确定肥胖是否会影响URS的有效性和安全性。
方法
2021年5月，我们在PubMed、EMBASE、Web of Science、Cochrane图书馆和ClinicalTrials.gov中进行了全面检索，以查找符合条件的研究。利用RevMan 5.3评估结石清除率（SFR）、手术时间、住院时间和并发症发生率。
结果
纳入了13项研究，涉及4583名正常体重患者（NWP）、2465名OP和291名病态肥胖患者（MOP）。汇总结果显示，OP和NWP之间的SFR在统计学上相似[比值比（OR）：1.09；95%置信区间（CI）：0.79，1.52；P = 0.59]，MOP和NWP之间也相似（OR：1.03；95%CI：0.46，2.31；P = 0.95）。OP和NWP之间的手术时间相似[平均差（MD）：-2.27；95%CI：-8.98，4.43；P = 0.51]，MOP和NWP之间也相似（MD：4.85；95%CI：-5.78，15.47；P = 0.37）。此外，OP和NWP之间的住院时间无显著差异（MD：-0.07；95%CI：-0.20，0.07；P = 0.33），MOP和NWP之间也无显著差异（MD：-0.06；95%CI：-0.25，0.14；P = 0.58）。此外，我们观察到OP和NWP之间的轻微并发症发生率相似（OR：1.04；95%CI：0.81，1.32；P = 0.78），MOP和NWP之间也相似（OR：1.29；95%CI：0.80，2.08；P = 0.30）。OP和NWP之间的严重并发症发生率差异（OR：0.97；95%CI：0.39，2.43；P = 0.95）以及MOP和NWP之间的差异（OR：2.01；95%CI：0.55，7.30；P = 0.29）也不显著。
结论
我们的研究表明，在MOP和OP中进行的URS似乎与NWP组具有相同的疗效和安全性。
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