耻骨后根治性前列腺切除术与标准腹腔镜下根治性前列腺切除术疗效比较的荟萃分析

Comparison of retropubic radical prostatectomy and standard laparoscopic radical prostatectomy： a meta-analysis

目的 采用荟萃分析的方法比较标准腹腔镜下根治性前列腺切除术（standard laparoscopic radical prostatectomy,SLRP）与耻骨后根治性前列腺切除术（retropubic radical prostatectomy,RRP）治疗局限性前列腺癌的效果.方法 通过计算机在PubMed、Web of Science、Cochrane Library及EMBASE数据库（1992年1月至2015年4月）中检索相关文献,入选文献必须对比SLRP与RRP的疗效,包含手术时间、出血量、输血率、留置导尿时间、住院时间、切缘阳性率、围手术期并发症、性功能恢复情况以及尿失禁恢复情况等指标中的至少一项,运用荟萃分析比较两种手术方式在治疗局限性前列腺癌疗效上的差异.结果 经筛选后共17篇文献纳入分析,其中RRP组6 430例,SLRP组3 601例.与RRP相比,SLRP的劣势在于手术时间较长（SMD=1.20,95％ CI0.83～ 1.58）,优势在于术中出血少（SMD=-2.02,95％CI-2.67～-1.37）,输血率低（RR =0.22,95％CI0.16～0.30）,留置导尿时间短（SMD=-1.44,95％CI-2.34～-0.54）和住院时间短（SMD=-0.97,95％CI-1.29～-0.66）,差异均有统计学意义（P＜0.05）.两种术式的切缘阳性率（RR=0.94,95％CI0.84～1.05）、围手术期并发症（RR =0.78,95％ CI0.60～ 1.02）、术后1年尿失禁情况（RR =0.85,95％CI0.57 ～ 1.28）及勃起功能恢复情况（RR=1.13,95％CI0.97 ～ 1.31）等方面比较差异均无统计学意义（P＞0.05）.结论 与RRP相比,SLRP具有出血少、创伤小、术后恢复快等优点,但手术治疗效果无显著性差异,因此,SLRP可能是治疗局限性前列腺癌更好的方法.但仍需开展多中心、大样本的随机对照研究以更好地评估两种手术方式的优劣.

Objective To compare the outcomes of standard laparoscopic radical prostatectomy （SLRP） and retropubic radical prostatectomy （RRP） via meta-analysis.Methods A systematic literature search of articles from January 1992 to April 2015 was conducted via Pubmed,Web of Science,Cochrane Library,and EMBASE databases,and the references of the retrieved articles.Fixed-or random-effect models were used to summarize the estimates to evaluate operation time,blood loss,transfusion,catheterization time,hospital stay,surgical margin status,perioperative complications,postoperative erectile dysfunction,and postoperative urinary incontinence in these two approaches.Results A total of 17 articles were included in this study.Compared with RRP group,the operation time was longer in SLRP group （SMD =1.20,95% CI 0.83,1.58）.On the contrary,the SLRP group held advantages in blood loss （SMD =-2.02,95% CI -2.67,-1.37）,transfusion （RR =0.22,95% CI 0.16,0.30）,catheterization time （SMD =-1.44,95 % CI-2.34,-0.54）,hospital stay （SMD =-0.97,95 % CI-1.29,-0.66） （P 〈 0.05）.Moreover,these two approaches showed no difference in surgical margin status （RR =0.94,95 % CI 0.84,1.05）,perioperative complications （RR =0.78,95% CI 0.60,1.02）,postoperative erectile dysfunction （RR =1.13,95 % CI 0.97,1.31）,and postoperative urinary incontinence （RR =0.85,95 % CI 0.57,1.28） （P 〉0.05）.Conclusions Compared with RRP,SLRP could be a more suitable approach to treat localized prostate cancer.Random clinical trials are needed in the future to better evaluate these two approaches.