经腹与经腹膜外途径机器人辅助腹腔镜根治性前列腺切除术治疗前列腺癌的Meta分析
发布时间：2018-06-13 14:24
本文选题：腹膜外 + 机器人 ； 参考：《兰州大学》2017年硕士论文
【摘要】：目的:采用Meta分析的方法比较经腹途径机器人辅助腹腔镜根治性前列腺切除术(transperitoneal robot-assisted laparoscopic radical prostatectomy,Tp-RALRP)与经腹膜外途径机器人辅助腹腔镜根治性前列腺切除术(extraperitoneal robot-assisted laparoscopic radical prostatectomy,Ep-RALRP)治疗前列腺癌的临床疗效及安全性。方法:通过计算机检索Pub Med,EMBASE,EBSCO,Cochrane library,万方(Wan fang),中国知网(CNKI),中国生物医学数据库(CBM)数据库中所有对比Tp-RALRP与Ep-RALRP疗效及安全性的临床研究,上述所有数据库的检索年限均为自2000年1月~2016年11月,同时辅以手工检索泌尿外科及男科方面的有关杂志。按照预先设定的文献纳入及排除标准,两位研究人员独立对所检索到的文献进行筛选,并对最终所纳入的研究进行质量评价及数据提取,最后对各项结局指标(手术时间、术中出血量、术后卧床时间、术后胃肠功能恢复时间、术后留置尿管时间、围手术期并发症发生率、与肠道有关的并发症发生率、术后病理切缘阳性率、术后尿道吻合口瘘发生率、术后不同时期控尿率)进行Meta分析。统计学软件采用Cochrane协作网提供的Rev Man5.3。结果:通过各数据库初步检索到的文献有224篇,Pub Med检索出36篇,EMBASE检索出88篇,EBSCO检索出70篇,Cochrane library检索出9篇,CNKI检索出6篇,wanfang检索出9篇,CBM检索出6篇文献,按照预先设定的纳入及排除标准,经仔细筛选后共有8篇文献纳入该研究,包括2个随机对照研究及6个非随机对照临床试验,其中Tp-RALRP组451例,Ep-RALRP组676例。Tp-RALRP与Ep-RALRP相比,在手术时间(WMD=21.39,95%CI 7.54~35.24,P=0.002)、术后卧床时间(WMD=0.4,95%CI 0.25~0.56,P=0.01)、围手术期并发症发生率(OR=1.93,95%CI 1.30~2.87,P=0.001)、与肠道有关的并发症发生率(OR=10.45,95%CI 3.42~31.92,P0.0001)、拔除尿管后即刻控尿率(OR=0.63,95%CI 0.42~0.95,P=0.03)、术后3月控尿率(OR=0.36,95%CI 0.13~0.98,P=0.05)等方面差异具有统计学意义。两种手术方式在术中出血量(WMD=16.34,95%CI-24.81~57.50,P=0.44)、术后留置尿管时间(WMD=0.19,95%CI-0.60~0.98,P=0.64)、术后胃肠功能恢复时间(WMD=0.14,95%CI-0.35~0.63,P=0.57)、术后病理切缘阳性率(OR=1.31,95%CI 0.93~1.85,P=0.12)、术后尿道吻合口瘘发生率(OR=0.98,95%CI 0.43~2.20,P=0.95)以及术后6月控尿率(OR=0.79,95%CI 0.11~5.66,P=0.81)等方面均无明显差异。结论:与Tp-RALRP相比,Ep-RALRP具有手术时间短、术后卧床时间短、围手术期并发症发生率低、与肠道有关的并发症发生率低、拔除尿管后即刻控尿率高、术后3月控尿率高等优点,因此,Ep-RALRP可能是手术治疗前列腺癌更好的方法。但未来仍然需要开展更多多中心、大样本量、随访时间长的随机对照试验进而更好地评估两种手术方式的优劣。
[Abstract]:Objective: to compare transperitoneal robot-assisted laparoscopic radical prostatectomyy Tp-RALRPs with transperitoneal robot-assisted laparoscopic radical prostatectomyy Ep-RALRPs by Meta-analysis. Clinical efficacy and safety of prostate cancer. Methods: all the clinical studies on the efficacy and safety of Tp-RALRP and Ep-RALRP were searched by computer in Pub Medus EMBASE EBSCOCOchrane libraryary, Wan Fang Fang Fang, CNKII, China Biomedical Database (CBM). All of the above databases were searched from January 2000 to November 2016, and the related journals of urology and andrology were searched by hand. According to the pre-set criteria for literature inclusion and exclusion, the two researchers independently sifted the retrieved literature, evaluated the quality of the final research and extracted the data, and finally evaluated the outcome indicators (operative time). The amount of blood lost during operation, the time of bed rest, the time of recovery of gastrointestinal function, the time of indwelling urinary catheter, the incidence of complications in perioperative period, the incidence of complications related to intestinal tract, the positive rate of pathological margin after operation, The incidence of postoperative urethral anastomotic fistula and the rate of urinary control at different stages after operation were analyzed by meta-analysis. The statistical software was provided by Rev Man5.3 by Cochrane collaboration. Results: a total of 224 papers were preliminarily retrieved from each database. 36 articles were retrieved from EMBASE, 88 articles were retrieved from EMBASE, 70 articles were retrieved from library, 9 articles were retrieved from library, 6 articles were retrieved from library, 9 articles were retrieved from EMBASE, and 6 articles were retrieved from EMBASE. According to the pre-set inclusion and exclusion criteria, a total of 8 articles were selected and included in the study, including two randomized controlled trials and six non-randomized controlled clinical trials. Among them, 451 cases in Tp-RALRP group were compared with Ep-RALRP group in 676 cases. Tp-RALRP was compared with Ep-RALRP. 鍦ㄦ墜鏈椂闂，
本文编号：2014317
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2014317.html
