原发性膀胱输尿管反流的膀胱外与膀胱内输尿管再植术：一项系统评价和荟萃分析

Extravesical vs. intravesical ureteric reimplantation for primary vesicoureteral reflux: A systematic review and meta-analysis.

作者信息

Law Zhi Wei, Ong Caroline C P, Yap Te-Lu, Loh Amos H P, Joseph Udayan, Sim Siam Wee, Ong Lin Yin, Low Yee, Jacobsen Anette S, Chen Yong

机构信息

Department of Urology, Singapore General Hospital, Singapore, Singapore.

Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.

出版信息

Front Pediatr. 2022 Oct 21;10:935082. doi: 10.3389/fped.2022.935082. eCollection 2022.

PURPOSE

This study aims to compare the outcomes of extravesical (EVUR) and intravesical (IVUR) ureteric reimplantation for primary vesicoureteral reflux (VUR) systematic review and meta-analysis.

METHODS

Literature review from Medline, Embase, and Cochrane since inception to March 2022 was performed. Meta-analysis was conducted on eligible randomized controlled trials (RCT) and observational cohort studies (OCS) comparing outcomes between EVUR and IVUR.

RESULTS

Twelve studies were included, comprising 577 patients (778 ureters) operated by EVUR and 395 patients (635 ureters) by IVUR. Pre-operative VUR grade, postoperative VUR persistence and hydronephrosis was not statistically significant. EVUR had shorter operative time [mean differences (MD) -22.91 min; 95% confidence interval (CI), -44.53 to -1.30, = 0.04] and hospital stay (MD -2.09 days; 95% CI, -2.82 to -1.36, < 0.00001) compared to IVUR. Bilateral EVUR had higher risk of postoperative acute urinary retention (ARU) (8.1%) compared to bilateral IVUR (1.7%) (OR = 4.40; 95% CI, 1.33-14.58, = 0.02). No patient undergoing unilateral EVUR or IVUR experienced ARU.

CONCLUSION

Both EVUR and IVUR are equally effective in correcting primary VUR. Operative time and hospital stay are shorter after EVUR compared to IVUR. However, bilateral EVUR is associated with higher risk of postoperative ARU.

目的

本研究旨在比较原发性膀胱输尿管反流（VUR）的膀胱外（EVUR）和膀胱内（IVUR）输尿管再植术的结果，进行系统评价和荟萃分析。

方法

对自开始至2022年3月的Medline、Embase和Cochrane数据库进行文献检索。对比较EVUR和IVUR结果的合格随机对照试验（RCT）和观察性队列研究（OCS）进行荟萃分析。

结果

纳入12项研究，包括577例接受EVUR手术的患者（778条输尿管）和395例接受IVUR手术的患者（635条输尿管）。术前VUR分级、术后VUR持续存在和肾积水无统计学意义。与IVUR相比，EVUR的手术时间更短[平均差异（MD）-22.91分钟；95%置信区间（CI），-44.53至-1.30，P = 0.04]，住院时间更短（MD -2.09天；95%CI，-2.82至-1.36，P < 0.00001）。双侧EVUR术后急性尿潴留（ARU）的风险高于双侧IVUR（1.7%）（8.1%）（OR = 4.40；95%CI，1.33 - 14.58，P = 0.02）。接受单侧EVUR或IVUR的患者均未发生ARU。