筋膜内与筋膜间保留性神经的前列腺癌根治术疗效比较的Meta分析

发布时间：2018-11-25 14:14

【摘要】：目的:系统评价筋膜内与筋膜间保留性神经的前列腺癌根治术的疗效,为临床上手术治疗局限性前列腺癌提供循证依据。方法:通过计算机系统检索Pub Med、Web of Science、Embase、Cochrane library、CNKI和万方数据库,查找比较保留性神经的筋膜内前列腺癌根治术与筋膜间前列腺根治术的临床对照研究相关文献,检索时限均从建库至2016年11月23日。按照纳入和排除标准,两位评价者独立对文献进行筛查、质量评价和数据提取,采用Revman 5.3软件进行Meta分析。研究指标包括手术时间、术中失血量、临床输血率、术后导尿管留置时间、切缘阳性率、术后生化无进展率、尿控恢复率和性功能恢复率。结果:本Meta分析共纳入6篇研究(2篇随机对照试验,4篇回顾性队列研究),共纳入前列腺癌患者1311例,其中筋膜内切除组患者558例(A组),筋膜间切除组患者753例(B组)。研究发现,筋膜内组与筋膜间组在术后导尿管留置时间(WMD=-46.54,95%CI[-62.05,-31.02],P0.00001)、术后尿控恢复率(3-mo,6-mo,12-mo)和术后性功能恢复率(3-mo,6-mo,12-mo)方面差异有统计学意义,筋膜内组明显优于筋膜间组。而在手术时间、术中失血量、临床输血率、切缘阳性率和术后生化无进展率方面两组无统计学差异。结论:两种手术方式均取得了较好的治疗效果,术后患者病情均得到有效控制。但相比筋膜间前列腺癌根治性切除术,筋膜内前列腺癌根治性切除术的患者术后尿控功能恢复情况及勃起功能恢复情况较好,且术后导尿管留置时间明显缩短。考虑本Meta分析纳入研究较少,病例数较少,故存在一定局限性,有必要开展和设计大样本随机对照研究来进一步验证此结果。
[Abstract]:Objective: to evaluate the curative effect of intrafascial and interfascial nerve preserving radical prostatectomy for local prostate cancer. Methods: Pub Med,Web of Science,Embase,Cochrane library,CNKI and Wanfang databases were searched by computer system to find the literature related to the clinical comparative study of radical resection of intrafascial prostate cancer and interfascial prostatectomy. The time limit for retrieval is from the construction of the database to November 23, 2016. According to the inclusion and exclusion criteria, the two evaluators independently screened the literature, evaluated the quality and extracted the data, and carried out Meta analysis with Revman 5.3 software. The parameters included operation time, blood loss during operation, clinical transfusion rate, postoperative catheter indwelling time, positive rate of incision margin, no progress rate of biochemistry after operation, recovery rate of urinary control and recovery of sexual function. Results: this Meta analysis included 6 studies (2 randomized controlled trials and 4 retrospective cohort studies), including 1311 patients with prostate cancer, including 558 patients with intrafascial resection (group A). There were 753 cases in interfascial resection group (group B). The time of catheter indwelling (WMD=-46.54,95%CI [-62.05- 31.02], P0.00001) and the recovery rate of urinary control (3-mo-6-mo.) were found in the intrafascial group and interfascial group. There was significant difference between 12-mo and postoperative sexual function recovery rate (3-mo-6-mo-12-mo). The intrafascial group was significantly better than the interfascial group. However, there was no significant difference between the two groups in the time of operation, the amount of blood lost during operation, the rate of clinical blood transfusion, the positive rate of incision margin and the rate of no progress in biochemistry after operation. Conclusion: the two kinds of operation methods have achieved better therapeutic effect, and the patients' condition has been effectively controlled after operation. But compared with radical resection of interfascial prostate cancer, the patients with radical resection of intrafascial prostate cancer had better recovery of urinary control function and erectile function after radical resection of intrafascial prostate cancer, and the postoperative indwelling time of catheter was shortened obviously. Considering the limited number of cases and the small number of cases in this Meta analysis, it is necessary to develop and design a large sample randomized controlled study to further verify the results.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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