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首页> 外文期刊>Nature reviews. Urology >Medical expulsive therapy for ureteral stones: where do we go from here?
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Medical expulsive therapy for ureteral stones: where do we go from here?

机译：输尿管结石的药物排除疗法：我们从这里去哪里？

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摘要

Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness in reducing time to stone passage, thus reducing the incidence of colic episodes, improving stone clearance and improving patients' quality of life. At least 11 systematic reviews and meta-analyses have been published showing clinical benefits of MET; however, the results of these analyses have been challenged by data from two randomized controlled, multicentre trials with large patient cohorts, thus providing higher quality evidence that MET is ineffective in patients with ureteral stones. Results of the various systematic reviews and meta-analyses have suggested that MET is effective, however, such analyses incorporate the biases and limitations of smaller cohort studies, resulting in their conclusions being based upon lower-quality evidence. Evidence for the use of MET for small (<5 mm) distal ureteral stones has weakened based on clinical trial data published in 2015. However, MET might remain effective in the management of larger ureteral stones (>5 mm).
机译：尽管有二十年的临床应用，但在过去的一年中，人们对药物排泄疗法（MET）在输尿管结石患者无创治疗方面的有效性提出了质疑。 MET的主要目的是加快结石通过，尽管它也显示出减少结石通过时间的效果，从而减少了绞痛发作的发生率，改善结石清除率并改善了患者的生活质量。至少已发表11篇系统评价和荟萃分析，显示MET的临床益处;但是，这些分析的结果受到了两项针对大型患者队列的随机对照，多中心试验的数据的挑战，因此提供了更高质量的证据，证明MET对输尿管结石患者无效。各种系统评价和荟萃分析的结果表明，MET是有效的，但是，此类分析包含了较小队列研究的偏见和局限性，导致其结论基于较低质量的证据。根据2015年发布的临床试验数据，在较小的（小于5毫米）输尿管远端结石使用MET的证据已经减弱。但是，MET可能在较大的输尿管结石（> 5毫米）的治疗中仍然有效。

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