机器人辅助腹腔镜前列腺癌根治术与腹腔镜术式的Meta分析

发布时间：2018-03-08 12:35

本文选题：前列腺癌　切入点：根治性前列腺切除术　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的评价机器人辅助腹腔镜前列腺癌根治术(RALP)与腹腔镜前列腺癌根治术(LRP)两种手术方式治疗局限性前列腺癌的疗效及安全性。方法搜集世界范围内2000～2013年关于对比RALP与LRP两种术式治疗局限性前列腺癌的随机对照试验和非随机对照试验,并搜索纳入研究文献的参考文献。计算机检索PubMed、Ovid、ScienceDirect、EMBASE、CBM、中国知网文献数据库、维普及万方等相关数据库。手工检索：检索《中华泌尿外科杂志》、《中华腔镜泌尿外科杂志》（电子版）、《临床泌尿外科杂志》、《中华男科学杂志》、《中国男科学杂志》等国内相关杂志（日期截止2013年12月）。根据纳入/排除标准筛选文献，两位研究者独立进行文献的筛选与提取，并交叉审核，当出现分歧意见时，通过讨论协商解决或者由第三方来决定。使用Rev-Man5.0软件进行Meta分析，并对手术时间、术中出血量、术后并发症、术后控尿功能、输血率、手术切缘阳性率及住院时间等指标整理报道。结果本篇Meta分析共纳入了12篇文献，共计6323例患者，其中行RALP术式的患者4461例，行LRP术式的患者1862例。Meta分析结果示：RALP手术时间短于LRP术式(WMD-19.36min，95%CI-35.44～-3.28min，P=0.02)，差异具有统计学意义。RALP术中出血量少于LRP(WMD-61.32ml，95%CI-120.22～-2.42ml，P=0.04)，差异具有统计学意义。LRP术后并发症较少于RALP(OR2.09，95%CI1.20～3.64，P=0.009)，差异具有统计学意义。两者术后一年控尿率RALP优于LRP(OR1.95，95%CI1.41～2.71，P＜0.0001)，差异具有统计学意义。患者围手术期输血率RALP与LRP之间差异无统计学意义(OR0.99，95%CI0.55～1.76，P＝0.96)。对于手术切缘阳性的发生率，RALP与LRP之间差异无统计学意义(OR1.08，95%CI0.76～1.52，P=0.67)。两种术式住院时间之间差异无统计学意义(WMD-0.46，95%CI-1.08～0.16，P=0.15)。结论对于局限性前列腺癌，机器人辅助腹腔镜与腹腔镜前列腺癌根治术的手术切缘阳性发生率、输血率及住院天数相似。RALP的手术时间较LRP短，，术后一年控尿率、术中出血量都优于LRP，但术后并发症略多于LRP，但由于所需输血量相对较少，以至于两种术式患者的输血率相似。两种术式均为微创手术，都是治疗局限性前列腺癌的安全有效的手段，由于纳入研究的文献可能存在发表偏倚，势必对部分研究结果产生一定的影响，因此需要我们在以后的工作中收集更多质量更高的文献对二者进行评价，为临床工作提供坚实、可靠的证据。
[Abstract]:Objective to evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) in the treatment of localized prostate cancer. Methods A randomized controlled trial and a non-randomized controlled trial were collected from 2000 to 2013 to compare RALP and LRP in the treatment of localized prostate cancer. Search for references included in the research literature. Computer search for PubMedOvidgen Science Direction CBM, China Knowledge-based Literature Database, Databases related to Weip and Wanfang. Manual retrieval: retrieval of Chinese Journal of Urology, Chinese Journal of Endoscopic Urology (Electronic Edition, Journal of Clinical Urology), Chinese Journal of andrology, Chinese Journal of andrology, etc. Relevant domestic magazines (as of December 2013). Screening of literature according to inclusion / exclusion criteria, The two researchers independently selected and extracted documents and cross-examined them. When there were differences of opinion, they were resolved through discussion or decided by a third party. Meta analysis was conducted using Rev-Man5.0 software, and the time of operation and the amount of blood lost during the operation were analyzed. Postoperative complications, postoperative urinary control function, blood transfusion rate, surgical margin positive rate and hospital stay were reported. Results A total of 12 articles were included in this Meta analysis, including 4 461 patients who underwent RALP operation. The results of Meta-analysis of 1862 patients undergoing LRP operation showed that the time of WMD-19.36 min 95 CI-35.44 min -3.28 min P0. 02 was shorter than that of LRP procedure, the difference was statistically significant. The amount of bleeding during RALP operation was less than that of LRPU WMD-61.32 ml 95CI-120.22- 2.42 ml P0.04, the difference was statistically significant. The complications after LRP operation were less than that of RALPOR2.09CI1.203.64P0.009, and the difference was statistically significant. One year after operation, the urinary control rate of RALP was better than that of LRP OR 1.9595, CI 1.41C 2.71g P < 0.0001.There was no significant difference between RALP and LRP in perioperative period. There was no significant difference between RALP and LRP. There was no significant difference between RALP and LRP in the positive margin of operation. There was no significant difference in the length of hospitalization between the two types of operation (WMD-0.46 ~ 95CI-1.08 ~ 0.16). Conclusion for localized prostate cancer, the positive rate of surgical margin, the blood transfusion rate and the length of stay in the operation of robot-assisted laparoscopic and laparoscopic radical prostatectomy are shorter than those of LRP, and the rate of urine control in one year after operation is shorter than that of LRP. The amount of intraoperative bleeding was better than that of LRP, but the postoperative complications were slightly more than that of LRP, but the blood transfusion rate of the two operations was similar because of the relatively small amount of blood transfusion required. They are both safe and effective means for the treatment of localized prostate cancer. Due to the publication bias that may exist in the literature included in the study, it is bound to have a certain impact on some of the results of the study. Therefore, we need to collect more quality and higher literature to evaluate the two in future work, to provide solid and reliable evidence for clinical work.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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