肾上腺部分切除术与肾上腺全切除术治疗醛固酮腺瘤效果比较的荟萃分析

A Meta- analysis to Compare Partial Adrenalectomy with Total Adrenalectomy for Aldosterone Producing Adenoma

目的 在醛固酮腺瘤的腹腔镜手术中,肾上腺部分切除术与全切除术选择指征仍存在较大争议。本研究旨在对腹腔镜肾上腺部分切除术(PA)与肾上腺全切除术(TA)治疗醛固酮腺瘤(APA)围手术期安全性及疗效进行比较。方法 在Pubmed、EMBASE、中国知网数据库中检索2000至2014年3月发表的比较腹腔镜肾上腺部分切除术(PA)与肾上腺全切除术(TA)治疗醛固酮腺瘤(APA)的临床对照研究,并应用Revman 5.2进行荟萃分析。分析的主要内容为围手术期结果(手术时间、住院时间、出血量)及远期疗效(治愈率、部分缓解率、无效率)。结果 8项研究最终入选,包括973例患者。荟萃分析显示,PA和TA在围手术期结果如手术时间、住院时间及术中失血量方面无明显统计学差异。在治疗效果,特别是治愈率上,PA和TA亦大致相同(OR 1.13,95%CI 0.75~1.70,P=0.57),但PA较TA治疗失败的风险相对较大(OR 1.99,95%CI 0.74~5.38,P=0.17),但尚未达到统计学差异。结论 对于醛固酮腺瘤,与TA相比,PA技术上安全可靠,具有相似的治疗效果,但少数患者有潜在的治疗失败的风险。

Objective The indication for laparoscopic total or partial adrenalectomy in patients with aldoste-rone producing adrenal adenoma remains controversial. We aims to compare the safety and efficiency of partial adrenalectomy (PA)with total adrenalectomy (TA)for patients with aldosterone producing adenoma (APA). Methods The Pubmed,EMBASE and CNKl were searched for clinical comparative studies published from 2000 to March 2014. Revman 5. 2 was used to perform the meta-analysis. The main outcomes were peri-operation outcomes such as operative time,length of hospital stay,intra-operative blood loss and therapeutic results such as cure rate,partial response rate and inefficacy rate. Results 8 studies with 973 patients were included into the final analysis. Meta-analysis demonstrated that PA was similar to TA in operative time,length of hospital stay and intra-operative blood loss rate. As for therapeutic results,especially in cure rates,they were also compara-ble (OR 1. 13,95%CI 0. 75~1. 70,P=0. 57). However,PA was associated with a relatively large inefficacy rate in compared with TA (OR 1 . 99 ,95%CI 0 . 74 ~5 . 38 ,P=0 . 17 ),but did not attain statistical signifi-cance. Conclusions Partial adrenalectomy is technically safe. Its therapeutic results is similar to those of total adrenalectomy,but few patients may fail to response.