腹腔镜与开放性肾部分切除术临床疗效比较的Meta分析

Meta-analysis of laparoscopic versus open partial nephrectomy

目的总结腹腔镜下肾部分切除术与开放性肾部分切除术的疗效差异，为临床治疗办案的选择提供循证依据。方法检索CHKD、PUBMED、万方、维普等数据库自建库至2012年6月30日国内外发表的有关腹腔镜下肾部分切除术与开放肾部分切除术疗效比较的临床对照研究相关文献，同时手检纳入文献的参考文献，按纳入排除标准由两人独立进行文献筛选、资料提取和质量评估后，采用RevMan5．1软件进行Meta分析。结果筛选到10篇文献，肾部分切除术患者1636例，其中腹腔镜下手术794例，开放于术842例。Meta分析结果显示：手术时间（SMD=0．10，95％CI-0．40～0．59，P=0．70），手术整体并发症（OR=1．03，95％CI 0．73～1．44，P=0．88），手术切缘阳性（OR=1．64，95％CI 0．83～3．23，P=0．16），术后肿瘤复发情况（OR=0．58，95％CI 0．26～1．30，P=0．18），肾热缺血时间（SMD=1．07，95％CI-0．02～2．16，P=0．05），以上方面两种术式比较差肄尢统计学意义，而在术中失血量（SMD=-1．08，95％CI-1．57～-0．59，P〈0．01）、术后住院时间（SMD=-0．81，95％CI-0．97～-0．65，P〈0．01）等方面比较差异有统计学意义。结论腹腔镜与开放性。肾部分切除术存手术整体并发症、术中肾热缺血时间、手术切缘阳性及术后肿瘤复发情况等方面无明显差异，而腹腔镜手术在术中失血量、术后住院时间方面优于于开放手术。

Objective To provide Meta-analysis evidence of laparoscopic partial nephrectomy （ LPN ） vs open partial nephrectomy （OPN） in assisting clinical decision making. Methods By searching CHKD, PUBMED, Waniang and VIP database self-buih library up to June 30, 2012, both Chinese and English literatures of LPN and OPN efficacy in controlled study were included with strict exclusion criteria by two independent screenings of the literature. Data extraction and quality assessment were done by using the RevMan 5.1 META analysis software. Results A total of four English and six Chinese literature were in- eluded in this Meta-analysis. There were 1636 cases of partial nephreetomies. Of these patients, 794 cases were treated with LPN, 842 cases were treated with OPN. Meta analysis results showed that ： in terms of op-erative time （ SMD = 0. 10, 95 % CI - 0. 40 - 0. 59, P = 0.70） , surgical complication （ OR = 1.03, 95 % CI 0.73 - 1.44, P =0.88） , positive surgical margin （OR = 1.64, 95% CIO. 83 - 3.23, P =0.16） , warm is-chemiatime （SMD =1.07, 95%C1 -0.02-2.16, P=0.05）, postoperative tumor recurrence （OR= 0.58, 95% CI0.26-1.30, P =0.18）, there was no significant difference. But in terms of intraoperative blood loss （SMD= -1.08, 95%C1 -1.57 - -0.59, P〈0.01）, postoperative hospital stay （SMD = -0.81, 95%C1 -0.97 - -0.65, P 〈0.01）, the differences were significant in favor of LPN. Conclusion Comparing with OPN, LPN has advantages in intraoperative blood loss and post-operative hos-pital stay, no obvious advantages in operative time, surgical complications, positive surgical margin, warm ischemia time and tumor recurrence.