目的:α受体阻滞剂可以减少输尿管收缩力和蠕动频率,降低放置输尿管通道鞘(ureteral access sheath,UAS)的阻力.较小的置鞘阻力与更低程度的置鞘损伤有关,并增加置鞘成功的可能性.目前相关研究的质量参差不齐,研究结果间存在差异.通过系统回顾和meta分析,评价术前应用α受体阻滞剂在置鞘过程中的作用.方法:系统检索PubMed、Web of Science和Cochrane library数据库,时间截至2023年3月1日,查找关于术前应用α受体阻滞剂对UAS置入影响的临床研究.按照术前是否应用α受体阻滞剂分为试验组和对照组,研究的主要结果为UAS置入成功率;次要结果为输尿管损伤、术后结石清除率.结果:经过筛选后共纳入8篇研究,899例患者.分析显示,试验组的置鞘成功率显著高于对照组(RR=1.08,95％CI:1.04～1.13,P＜0.05).对药物种类的亚组分析显示,坦索罗辛和西洛多辛在置鞘过程中的效应相似(P＞0.05).依据输尿管损伤的PULS分级,对不同输尿管损伤等级进行亚组分析显示,≥0级输尿管损伤2组差异无统计学意义(RR=0.99,95％CI:0.86～1.13,P＞0.05);≥1 级输尿管损伤在试验组更低(RR=0.64,95％CI:0.44～0.93,P＜0.05);≥2级输尿管损伤2组差异无统计学意义(RR=0.47,95％CI:0.20～1.09,P＞0.05).2组具有相似的术后结石清除率(RR=1.04,95％CI:0.93～1.17,P＞0.05).结论:术前应用α受体阻滞剂可提高UAS置入成功率,可能与较低的输尿管损伤等级有关.坦索罗辛和西洛多辛在置鞘过程中的效应相似.
Meta-analysis of the effect of alpha blockers on ureteral access sheath placement during flexible ureteroscopic lithotripsy
Objective:To evaluate the role of α receptor blockers in the process of ureteral access sheath(UAS)placement before surgery through systematic review and meta-analysis.Methods:A systematic search of PubMed,Web of Science and Cochrane library databases up to March 1st,2023 was conducted to find clinical studies on the effect of preoperative alpha-blockers on sheath placement.The main results of the study were the success rate of UAS placement.Secondary outcomes were ureteral injury and postoperative stone free rate(SFR).Results:After screening,a total of 8 studies with 899 patients were included.The results of analysis showed that the success rate of placement in the α-blocker group was significantly higher than that in the control group(RR=1.08,95％CI:1.04-1.13,P＜0.05).Subgroup analysis of drug types showed that tamsulosin and silodosin had similar effects during sheath placement(P＞0.05).According to PULS grade of ureteral injury,subgroup a-nalysis of ureteral injury grade ≥0 was similar between the two groups(RR=0.99,95％CI:0.86-1.13,P＞0.05).Grade ≥1 ureteral injury was lower in the α-blocker group(RR=0.64,95％CI:0.44-0.93,P＜0.05).Grade ≥2 ureteral injury was similar between the two groups(RR=0.47,95％CI:0.20-1.09,P＞0.05).The post-operative SFR was similar between the two groups(RR=1.04,95％CI:0.93-1.17,P＞0.05).Conclusion:Preoper-ative application of alpha-blockers increased the success rate of UAS placement,which may be associated with a lower grade of ureteral injury.The effects of tamsulosin and silodosin in the process of sheath placement are similar.
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