机器人辅助腹腔镜与开腹、腹腔镜手术治疗膀胱癌、前列腺癌疗效比较的Meta分析

Robot-assisted laparoscopic operation versus laparotomy and laparoscopy for bladder cancer and prostate cancer:a Meta-analysis

目的比较机器人辅助腹腔镜与开腹、腹腔镜手术分别治疗膀胱癌、前列腺癌的临床疗效及其应用价值。方法检索PubMed、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、万方数据知识服务平台、中国CNKI学术总库,收集机器人辅助腹腔镜与开腹、腹腔镜手术治疗膀胱癌、前列腺癌随机对照试验,检索时间截至2014年10月7日。由2名研究者独立按照纳入标准筛选文献、提取资料并交叉核对,对纳入研究进行质量评价,用RevMan 5.2软件进行Meta分析。结果共纳入3个研究,包括273例患者。Meta分析结果显示,治疗膀胱癌组,机器人辅助腹腔镜在术中出血量、术后肠道通气时间及住院天数均少于开腹手术(P<0.05),但手术时间延长;治疗前列腺癌组,机器人辅助腹腔镜手术不能缩短手术时间、也不能明显减少术中出血量,但在术后第3、6、12个月患者尿控和阴茎勃起功能恢复率方面,机器人辅助腹腔镜明显优于腹腔镜手术(P<0.05)。结论机器人辅助腹腔镜治疗膀胱癌、前列腺癌优于开腹、腹腔镜手术,是一种微创、可供选择应用的新方法。

Objective The comparison of the clinical curative effect and applied value of robot-assisted laparoscopic surgery,laparotomy and laparoscopy for bladder cancer and prostate cancer. Methods Databases including PubMed,Cochrane Library,Chinese biomedical literature database and Chinese Science Technology Journal Full-text Database and Chinese journal full text database were searched for comparing the randomized controlled trials（RCTs）of robot-assisted laparoscopy,laparotomy and laparoscopy for bladder cancer and prostate cancer.The search was performed up to October,2014.Two researchers independently in accordance with the inclusion criteria screened literature,extracted data and crossed check,to evaluate the quality of included studies.Meta analysis was carried out using RevMan 5.2software. Results Totally our article included 3studies involving 273 patients.Results of the Meta analysis showed that in the group of bladder cancer,compared to laparotomy,robot-assisted laparoscopy is associated with reduced estimated blood loss,time to flatus and length of stay（P〈0.05）,but increased operation.In the group of prostate cancer,the result shows that there are no differences between operation time and operative blood loss.But in the aspect of urinary continence as well as erectile function at 3-month,6-month and 12-month,robot-assisted laparoscopy was significantly better than laparoscopy（P〈0.05）. Conclusions Robot-assisted laparoscopic surgery for bladder cancer and prostate cancer is superior to the laparotomy and laparoscopy.It is a new minimally invasive method.