腹腔镜下与开放式根治性膀胱切除术临床疗效及安全性的荟萃分析

Laparoscopic radical cystectomy versus open radical cystectomy for the treatment of muscle invasive bladder cancer：a meta-analysis

目的：荟萃分析腹腔镜下根治性膀胱切除术（laparoscopicradicalcystectomy，LRC）及开放式根治性膀胱切除术（openradicalcystectomy，ORC）治疗肌层浸润性膀胱肿瘤的疗效及安全性。方法计算机检索CochraneLibrary、PubMed、EMbase、SCI、Ovid、中国生物医学文献数据库、万方、维普和中国知网数据库，收集LRC与ORC治疗肌层浸润性膀胱癌的随机或非随机同期对照试验，检索时限截至2013年5月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后，采用RevMan5．2．6软件进行荟萃分析。结果纳入13个非随机对照试验，共783例患者。Meta分析结果显示：LRC较ORC术中出血量少[MD＝-466．85，95％CI（-603．33，-330．37），P＜0．001）]，输血率低[OR＝0．27，95％CI（0．18，0．41），P＜0．001]，术后住院时间短[MD＝-3．46，95％CI（-5．98，-0．94），P＝0．007]，术后恢复进食时间早[MD＝-1．16，95％CI（-1．41，-0．90），P＜0．001]，术后轻微并发症少[OR＝0．52，95％CI（0．30，0．89），P＝0．020]，手术切缘的阳性率低[OR＝0．25，95％CI（0．10，0．58），P＝0．001]，淋巴结阳性率低[OR＝0．61，95％CI（0．40，0．92），P＝0．020]，但手术时间比开放手术长[MD＝52．44，95％CI（36．67，68．21），P＜0．001]。腹腔镜手术与开放手术在淋巴结清扫数目、肿瘤局部复发及远处转移方面比较差异无统计学意义（P＞0．05）。结论在严格掌握LRC治疗肌层浸润性膀胱癌适应证的前提下，采用LRC治疗肌层浸润性膀胱癌是安全可行的。由于纳入研究数量和质量存在局限性，仍需大样本、高质量的临床对照研究进一步验证。

Objective To systematically evaluate the effectiveness and safety of laparoscopic radical cystectomy （LRC） versus open radical cystectomy （ORC）.Methods The databases of Cochrane Library , PubMed, EMbase, SCI, Ovid, CBM, WanFang Data Knowledge Service Platform , VIP Information Chinese Science and China National Knowledge Infrastructure , were searched to collect the randomized controlled trails （ RCTs） and non-RCTs about LRC versus ORC for the treatment of muscle invasive bladder cancer . The retrieval time span was from inception to May 2013.The studies were screened according to the inclusion and exclusion criteria , the data were extracted and the quality was evaluated by 2 reviewers independently.The meta-analysis was conducted using RevMan 5.2.6 software.Results A total of 13 non-RCTs involving 783 patients were included .The meta-analysis showed that comparing with ORC , LRC had lesser intraoperative blood loss [MD =-466.85,95%CI（ -603.33, -330.37）, P 〈0.001], lower transfusion rate [OR =0.27, 95%CI（0.18, 0.41）,P 〈0.001], shortening postoperative hospital stay [MD=-3.46, 95%CI（-5.98,-0.94）, P=0.007], shortening time to oral intake [MD=-1.16, 95%CI（-1.41, -0.90）, P〈0.001], lesser minor complications [OR=0.52, 95%CI（0.30, 0.89）, P=0.020], lower positive margins [OR=0.25, 95%CI（0.10,0.58）,P=0.001], lower positive lymphs [OR=0.61, 95%CI（0.40, 0.92）,P=0.020], but longer operative time[MD=52.44, 95%CI（36.67, 68.21）, P〈0.001].There were no significant differences between LRC and ORC in lymph node yield , local recurrence and distant metastases （ P〉0.05 ） .Conclusions LRC is safe and feasible for treating muscle invasive bladder cancer when its indications are strictly controlled .However, for the quantity and quality limitation of the involved studies , this conclusion still requires to be further proved by large and high quality studies.