机器人辅助腹腔镜根治性前列腺切除术：经腹膜与经腹膜外入路疗效比较的Meta分析

发布时间：2018-07-17 16:40

【摘要】：目的:评价经腹膜途径与经腹膜外途径行机器人辅助腹腔镜根治性前列腺切除术治疗局限性前列腺癌的疗效和安全性。方法:采用计算机综合检索PubMed,the Cochrane Library,Web of Science,中国知网文献数据库(CNKI)、维普中文科技期刊全文数据库、万方数据库中公开发表的文献,同时手工检索图书馆内相关内容的期刊,检索时间截止至2016年12月。由两名本课题组的研究人员按照制定好的检索策略以及纳入、排除标准相互独立进行筛选并提取数据,当两人意见存在分歧时,则通过讨论达成共识或者请第三名研究人员参与评判。对符合标准的研究进行质量评价,并使用RevMan 5.3统计软件进行Meta分析。结果:本篇Meta分析共纳入了8篇文献,其中2篇属于随机对照实验,6篇是病例对照研究。共有1127例患者纳入研究,其中采用E-RALRP 676例,采用T-RALRP451例。Meta分析结果显示:E-RALRP组手术时间短于T-RALRP组(WMD,-19.22;95%CI,-28.70~-9.74;p0.0001);术中出血量在E-RALRP组与T-RALRP组之间差异无统计学意义(WMD,-8.84;95%CI,-45.68~27.99;p=0.64);对于切缘阳性率,E-RALRP组与T-RALRP组之间差异无统计学意义(OR,0.86;95%CI,0.61~1.20;p=0.37);E-RALRP组的住院时间较T-RALRP组更短(WMD,-0.65;95%CI,-1.25~-0.05;p=0.04);术后并发症的发生率E-RALRP组比T-RALRP组少(OR,0.48;95%CI,0.32~0.72;p=0.0004);术后肠道并发症的发生率E-RALRP组少于T-RALRP组(OR,0.13;95%CI,0.04~0.45;p=0.001);术后插导尿管时间在E-RALRP组与T-RALRP组之间差异无统计学意义(WMD,-0.19;95%CI,-0.98~-0.60;p=0.64);对于术后即刻、3个月以及6个月控尿功能的比较上E-RALRP组与T-RALRP组之间差异无统计学意义,其中刻控尿功能(OR,2.00;95%CI,0.57~7.08;p=0.28),3个月控尿功能(OR,1.59;95%CI,0.74~3.44;p=0.24),6个月控尿功能(OR,1.46;95%CI,0.58~3.70;p=0.43)。结论:经腹膜外途径行机器人辅助腹腔镜根治性前列腺切除术在治疗局限性前列腺癌是安全有效的,且在手术时间、住院天数、术后并发症以及术后肠道并发症指标上比传统经腹膜途径更能让患者获益,临床上可以针对患者病情及医疗水平选择最佳的术式。
[Abstract]:Objective: to evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy in the treatment of localized prostate cancer via peritoneal approach and extraperitoneal approach. Methods: a comprehensive computer search method was used to search the published articles in PubMeden the Cochrane Library Web of Science and Technology, CNKI, the full text database of Chinese scientific and technological journals in Weipu and Wanfang database, and to retrieve the journals of relevant contents in the library by hand at the same time. The search time is up to December 2016. Two researchers from our team sifted and extracted data independently of each other according to the established search strategy and inclusion criteria, and when the two people had different opinions, A consensus is reached through discussion or a third researcher is invited to participate in the judgment. The quality of the standard was evaluated and Meta-analysis was carried out with Revman 5.3 statistical software. Results: a total of 8 articles were included in this meta-analysis, of which 2 were randomized controlled trials and 6 were case-control studies. A total of 1127 patients were included in the study, of whom 676 were treated with E-RALRP. 閲囩敤T-RALRP451渚，

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