机器人辅助肾部分切除术与腹腔镜肾部分切除术临床效果比较的Meta分析

Clinical Effect of Robotics-assisted and Laparoscopic Partial Nephrectomy:A Meta-analysis

背景目前关于机器人辅助肾部分切除术(RPN)和腹腔镜肾部分切除术(LPN)的效果和安全性均存在一定争论。目的对比分析RPN和LPN的临床效果。方法以"Robotics AND Nephrectomy""Robotics AND Nephrectomy AND Laparoscopy""Robotics AND Laparoscopy AND Nephrectomy AND Partial""LPN AND RPN"为英文检索词,以"机器人辅助肾部分切除术AND腹腔镜肾部分切除术"为中文检索词,在PubMed、CNKI及维普数据库中检索从建库至2013-05-31发表的随机对照试验,利用Review Manager 5.2.5(Java 6)软件进行数据处理,对RPN组和LPN组的估计出血量、手术时间、热缺血时间、并发症、切缘阳性及住院时间进行分析。结果共筛选出10篇符合要求的文献,均为外文文献。RPN组和LPN组的估计出血量间差异有统计学意义〔标准差(MD)=40.70,95%CI(24.46,56.93),Z=4.91,P<0.01〕,但手术时间〔MD=4.21,95%CI(-21.76,30.19),Z=0.32,P=0.75〕、热缺血时间〔MD=-2.91,95%CI(-8.19,2.37),Z=1.38,P=0.28〕、并发症发生率〔OR=1.25,95%CI(0.66,2.36),Z=0.68,P=0.50〕、切缘阳性率〔OR=0.99,95%CI(0.46,2.14),Z=0.02,P=0.98〕及住院时间〔OR=-0.04,95%CI(-0.22,0.14),Z=0.44,P=0.66〕间差异均无统计学意义。亚组分析显示,RPN组和LPN组估计出血量〔MD=-6.89,95%CI(-99.82,86.04),P=0.88〕和手术时间〔MD=11.32,95%CI(-25.90,48.55),P=0.55〕间差异无统计学意义,但RPN组热缺血时间少于LPN组〔MD=-2.83,95%CI(-4.53,-1.13),P=0.001〕。结论 RPN和LPN具有同样的手术效果,且RPN热缺血时间较LPN短,这对保护肾功能有积极作用。

Background It remains controversial in term of the efficacy and Safety of the robotics - assisted partial ne- phrectomy （RPN） and laparoseopic partial nephreetomy （LPN） . Objective To evaluate the clinical effect of RPN and LPN. Methods PubMed, CNKI and VIP were searched by using the terms Robotics AND Nephrectomy, Robotics AND Ne- phrectomy AND Laparoscopy, Robotics AND Laparoseopy AND Nephrectomy AND Partial, LPN AND RPN among the data ran- ging from the building of database to May 31st, 2013. The related literature protocol was applied. A cumulative analysis was con- ducted by using Review Manager Software 5.2. 5 （ Java 6） . The following variables were compared ： estimated blood loss, oper- ating time, warm ischemie time, complications, positive margin and length of hospital stay. Results A total of 10 literatures were isolated, and they were all in foreign languages. The estimated blood loss between RPN group and LPN group showed statisti- cally significant difference[ MD = 40. 70, 95% CI （24.46, 56. 93 ）, Z = 4. 91, P 〈 0. 01 ], but operating time[MD = 4. 21, 95%CI （-21.76, 30. 19）, Z=0.32, P=0.75], warm ischemic time [MD=-2.91, 95%CI （-8.19, 2.37）, Z= 1.38, P = 0. 28 ], complications [ OR = 1.25, 95 % CI （0. 66, 2.36）, Z = 0. 68, P = 0. 50 ], positive margin [ OR = 0. 99, 95%CI （0.46, 2. 14）, Z=0.02, P=0.98] and hospital stay [OR= -0.04, 95%CI （ -0.22, 0.14）, Z=0.44, P= 0. 66 ] showed no statistically significant difference. Subgroup analysis showed that the estimated blood loss [ MD = - 6. 89,95%CI （-99.82, 86.04）, P=0.88]and operating time[MD=11. 32, 95%CI （-25.90, 48.55）, P=0.553 showed no statistically significant difference between RPN group and LPN group, but the ischemia time in RPN group was less than the LPN group[MD= -2.83, 95%CI （-4.53, -1.13）, P=0.001] .Coneltmion RPN and LPH have exerted the same effeet on the operation, and RPN has less ischemia time than LPN, which plays a positive role in the protection of the renal function.