结直肠外科手术中的预防性尿路支架:一个元分析和系统审查
Bernardo Fontel Pompeu1,2,3, Camila Tur de Arruda Ribeiro4, Eric Pasqualotto5
1Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil. bernardo.pompeu@online.uscs.edu.br.
International urology and nephrology
|October 8, 2024
概括
结直肠手术中的预防性尿路支架没有减少尿路损伤,但增加了急性损伤 (AKI) 和手术时间. 在尿路感染 (UTI),血或住院期间没有发现显著差异.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
背景情况:
- 在结直肠手术期间意外尿路损伤是一种罕见但严重的并发症.
- 这种伤害增加了尿路感染 (UTI) 和急性损伤 (AKI) 的风险.
- 建议使用预防性双J支架,以帮助尿管识别并降低受伤风险.
研究的目的:
- 评估预防性尿路支架在预防结直肠手术期间意外尿路损伤的疗效.
- 评估预防性尿路支架对诸如尿路感染和AKI等相关并发症的影响.
- 分析预防性尿路支架对手术时间和患者死亡率的影响.
主要方法:
- 系统审查和对2024年3月之前发表的观察性研究进行元分析.
- 搜索的数据库:MEDLINE,Cochrane,临床试验中央注册表和科学网.
- 使用随机效应模型的95%置信区间 (CI) 聚合赔率比率 (ORs);通过科克兰Q测试和I2统计评估异质性.
主要成果:
- 11项研究包括71,784名患者;16.4%接受了预防性尿道支架.
- 支架组和非支架组之间尿道损伤率没有显著差异 (0.66%对0.8%;OR 1.45;p=0.552).
- 支架增加了AKI (1.7%对0.56%; OR 1.54; p<0.001) 和手术时间 (MD 24.8分钟; p=0.01),但死亡率降低 (OR 0.11; p<0.001).
结论:
- 在结直肠外科手术中,预防性尿路支架并不能显著减少尿路损伤.
- 支架与AKI的风险增加和更长的手术时间有关.
- 没有观察到尿路感染,出血,住院时间或重新手术率的显著差异.
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