Meta-analysis of the comparative effectiveness between lingual and buccal mucosa in the treatment of ureteral strictures
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摘要: 目的 评价口腔黏膜舌黏膜输尿管成形术和颊黏膜输尿管成形术的结果，并确定2种自体组织的相对优点，为临床治疗输尿管狭窄提供循证证据。 方法 检索数据库(包括PubMed、Web of Science、The Cochrane Library、知网和万方数据)，寻找建库至2023年12月27日评估舌黏膜输尿管成形术和颊黏膜输尿管成形术结果的符合条件的试验。分析的变量包括重建成功率、狭窄长度、住院时间、围手术期并发症和远期并发症。 结果 共纳入16项单臂研究，共220例患者。舌黏膜组和颊黏膜组的重建成功率分别为99.0%(95%CI：95.0%~100.0%)和94.0%(95%CI：88.0%~99.0%)；修复的长度分别为4.25 cm(95%CI：3.52~4.98)和3.81 cm(95%CI：2.99~4.63)；住院天数分别为7.37 d(95%CI：6.01~8.74)和5.45 d(95%CI：0.95~9.96)；术后并发症发生率分别为16.0%(95%CI：7.0%~26.0%)和26.0%(95%CI：14.0%~41.0%)，低级别术后并发症发生率分别为14.0%(95%CI：6.0%~25.0%)和16.0%(95%CI：6.0%~29.0%)，高级别术后并发症发生率为5.0%(95%CI：1.0%~12.0%)。 结论 现有证据表明，舌黏膜补片与颊黏膜补片相比，在手术成功率、自体组织取材长度、术后并发症发生率方面具有优势，推荐舌黏膜输尿管成形术作为口腔黏膜输尿管成形术的首选重建手术。为比较证明舌黏膜与颊黏膜补片在临床应用中的效果尚需大样本、长期随访及高质量的研究进一步验证。Abstract: Objective To describe the results of lingual mucosa ureteroplasty and buccal mucosa ureteroplasty, and to determine the relative advantages of the two kinds of autologous tissues, so as to provide evidence-based proof for clinical treatment of ureteral stricture. Methods We searched the databases (including PubMed, Web of Science, The Cochrane Library, CNKI and WanFang Data) from date of establishment to December 27th, 2023 to find the trials evaluating the results of lingual mucosa ureteroplasty and buccal mucosa ureteroplasty. The variables analyzed included success rate of reconstruction, length of stenosis, length of hospital stay, perioperative complications and long-term complications. Results A total of 220 patients with 16 single arm studies were included. The success rates of reconstruction in lingual mucous membrane group and buccal mucosa group were 99.0% (95%CI: 95.0%-100.0%) and 94.0% (95%CI: 88.0%-99.0%), respectively. The length of repair in lingual mucous membrane group and buccal mucosa group were 4.25 cm (95%CI: 3.52-4.98) and 3.81 cm (95%CI: 2.99-4.63), respectively. The hospitalization time of lingual mucous membrane group and buccal mucosa group were 7.37 days (95%CI: 6.01-8.74) and 5.45 days (95%CI: 0.95-9.96), respectively. The incidence of postoperative complications in lingual mucous membrane group and buccal mucosa group were 16.0% (95%CI: 7.0%-26.0%) and 26.0% (95%CI: 14.0%-41.0%). The incidence of postoperative complications in low-level group were 14.0% (95%CI: 6.0%-25.0%) and 16.0% (95%CI: 6.0%-29.0%). The incidence of high-level postoperative complications of the two groups were both 5.0% (95%CI: 1.0%-12.0%). Conclusion The available evidence shows that compared with buccal mucosa patch, lingual mucosa patch has advantages in operation success rate, autologous tissue removal length and postoperative complication rate. In order to compare and prove the effect of lingual mucosa patch and buccal mucosa patch in clinical application, large samples, long-term follow-up and high-quality researches are needed to further verify.
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表 1 舌黏膜和颊黏膜补片治疗患者基本资料
作者 组别 例数 输尿管狭长/cm 手术时间/min 术中出血量/mL 术后住院天数/d 质量评价 孙林2023[6] 舌黏膜 7 5.07(3.5~6) 260(240~300) 80(60~100) - 10 李志华2022[7] 舌黏膜 6 4.8±1.5 226.7±70.8 44.2±21.7 7.0±4.1 14 沈天一2021[8] 颊黏膜 4 2.9(2.5~3.5) 236(210~260) 75(50~100) - 10 程嗣达2020[9] 舌黏膜 5 4.5(3.0~5.0) 204(154~250) 30(10~100) 6(4~7) 13 许皓翔2023[10] 舌黏膜 8 3.1±0.7 226.9±22.8 93.8±25.9 11.1±3.6 14 江羽2021[11] 颊黏膜 10 3.2±0.7 199.2±27.4 101.5±54.7 7.9±1.9 12 葛光炬2018[12] 颊黏膜 5 3(2~6) 360(200~400) 100(50~200) 11(7~12) 13 Liang CQ 2022[13] 舌黏膜 41 4.8(2.0~8.0) 166(98~306) 65(15~220) 7(4~12) 14 Yang KL 2022[14] 舌黏膜 12 4.7(3~6.5) 197.1(130~346) 49.2(10~200) 6(4~14) 14 Lee Z 2017[15] 颊黏膜 12 3(2~5) 217(136~344) 100(50~200) 1(1~6) 13 Katibov MI 2018[16] 颊黏膜 44 6.0(2.5~11.0) - - - 9 Zhao LC 2018[17] 颊黏膜 19 4.0(2.0~8.0) 200(136~397) 95(25~420) 2(1~15) 13 Fan SB 2021[18] 舌黏膜 10 3(3~5) 237(189~310) 40(10~100) 7.5(5~22) 12 Badawy AA 2010[19] 颊黏膜 5 4.4(3.5~5.0) 106(85~130) - - 10 Guliev BG 2023[20] 颊黏膜 24 3.6 208.3 75.8 7.3 10 Trapeznikova MF 2014[21] 颊黏膜 8 5.1 - - - 9 
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