腹腔镜前列腺癌根治术与开放术式的疗效比较Meta分析

Laparoscopic radical prostatectomy versus open radical prostatectomy:a Meta analysis

目的利用Meta分析的方法,评价腹腔镜前列腺癌根治术(LRP)与开放前列腺癌根治术(ORP)两种手术方式治疗局限性前列腺癌的疗效。方法选取发表于1990～2011年的文献,对比LRP与ORP两种术式治疗局限性前列腺癌的随机对照试验和临床对照试验,并应用Meta分析评价手术时间、术中出血量、输血情况、切缘阳性率、术后尿道狭窄发生率、术后控尿、术后勃起功能等相关指标。结果本篇Meta分析,共分析了14篇临床同期对照试验。共纳入了9006例患者,其中行LRP3261例患者,行ORP5745例患者。对于切缘阳性的发生率,腹腔镜与ORP之间无统计学差异(OR0.88,95%CI0.77～1.01,P=0.06);LRP手术时间长于开放手术(WMD60.25min,95%CI30.83～89.68min,P<0.0001),差异具有统计学意义。LRP术中出血量小于ORP(WMD-686.61ml,95%CI-1101.49～-271.72ml,P=0.001),差异具有统计学意义。LRP患者输血率低于ORP(OR0.17,95%CI0.10～0.29,P<0.0001),差异具有统计学意义。LRP术后尿道狭窄的发生率低于ORP(OR0.32,95%CI0.14～0.71,P=0.005),差异具有统计学意义。LRP的术后一年控尿率与ORP无统计学差异(OR1.29,95%CI0.88～1.89,P=0.20)。术中保留双侧性神经的患者的术后一年勃起功能,LRP优于ORP(OR2.23,95%CI1.48～3.36,P=0.0001)。结论对于局限性前列腺癌,腹腔镜与ORP的切缘阳性发生率和术后一年控尿功能相似。LRP的手术时间长于ORP,但术中出血量少于ORP,患者输血率小于ORP,且术后尿道狭窄发生率和术后一年阳痿发生率小于ORP。

Objective To compare outcomes of laparoscopic and open radical prostatectomy using Meta analysis.Methods Retrieved clinical trials comparing laparoscopic radical prostatectomy with open radical prostatectomy for the treatment of localized prostate cancer published from 1990 to 2011.We performed Meta-analysis to evalulate the primary outcomes including operation time,operative blood loss,perioperative transfusion,surgical margin status,postoperative bladder urethral anastomotic stricture,postoperative urinary incontinence,and postoperative erectile dysfunction.Results 14 clinical controlled trials were included in this analysis.These studies included a total of 9006 patients:3261 treated with LRP and 5745 treated with ORP.The differences in surgical margin status(OR 0.88,95% CI 0.77-1.01,P=0.06)and 1-year urinary continence(P=0.20)were not statistically significant between the LRP and ORP groups.In the LRP group the operation time was significantly longer than in the ORP group(WMD 60.25 min,95% CI 30.83-89.68 min,P<0.0001).LRP group experienced less operative blood loss(WMD -686.61 ml,95% CI-1101.49^-271.72 ml,P=0.001)and was 88% less likely to receive a perioperative transfusion(OR 0.17,95% CI 0.10-0.29,P<0.0001).LRP group was also 66% less likely to occur anastomotic stricture(OR 0.32,95% CI 0.14-0.71,P=0.005).LRP was better than ORP in 1-year erectile function(OR 2.23,95% CI 1.48-3.36,P=0.0001).Conclusions Our results suggest that,for the treatment of localized prostate cancer,compared with open radical prostatectomy,laparoscopic radical prostatectomy is associated with longer operation time,decreased operative blood loss,decreased risk of transfusion,decreased risk of postoperative anastomotic stricture,increased 1-year potent rate,and similar risk of positive surgical margin and 1-year urinary continence.