根治性前列腺切除术中保留膀胱颈对术后控尿功能恢复影响的Meta分析被引量：9

Urinary continence and pathological outcome after bladder neck preservation during radical prostatectomy： a systematic review and meta-analysis

原文传递

导出

摘要目的系统评价根治性前列腺切除术中保留膀胱颈的安全性和有效性.方法计算机检索PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献数据库、万方数据库中关于根治性前列腺切除术中保留膀胱颈和不保留膀胱颈的对比研究.检索时间均从建库至2015年7月.由2名评价员共同评价纳入研究的质量,采用RevMan 5.0软件对两种术式对术后控尿功能恢复、手术切缘阳性率的影响进行Meta分析.结果共纳入12篇病例对照研究和2篇随机对照研究.共包括3 391例患者,其中2篇随机对照研究包含277例患者,12篇观察性研究包含3 114例患者（保留膀胱颈组1 985例,未保留膀胱颈组1 129例）.对12篇病例对照研究行Meta分析结果显示,保留膀胱颈组与未保留膀胱颈组比较,手术切缘阳性率[OR=0.92,95％ CI0.71 ～ 1.19,P=0.52],以及术后6个月[OR=1.49,95％ CI0.97 ～2.29,P=0.07]、12个月[OR =0.99,95％CI0.70～1.39,P=0.93]的控尿率差异均无统计学意义,但保留膀胱颈组术后1个月[OR =2.88,95％CI1.80 ～4.60,P ＜0.05]、3～4个月[OR =2.32,95％CI1.42 ～ 3.80,P＜0.05]的控尿率明显高于未保留膀胱颈组,差异均有统计学意义.结论根治性前列腺切除术中保留膀胱颈有利于患者术后早期控尿功能的恢复,且不增加手术切缘阳性率. Objective To conduct a systematic review to evaluate efficacy and safety of bladder neck preservation techniques during radical prostatectomy.Methods We searched PubMed,Embase,Medline,Central （the Cochrane Library,Issue 1,2013）,CNKI,CBM from the inception to July 2015 for randomized or observational studies assessing the influence of preservation of bladder neck on the continence recovery and cancer control outcomes after radical prostatectomy.Two researchers evaluated the quality of included studies.A meta-analysis was conducted using Review Manager 5.0 software.Results Twelve observational and two randomized studies were analyzed.BNP group had a faster recovery of early continence than non-BNP group at 1 month[OR =2.88,95% CI 1.80-4.60,P 〈 0.05],3-4 months [OR =2.32,95% CI 1.42-3.80,P 〈 0.05].However there was no statistically significant difference in terms of continence rate at 6 months [OR =1.49,95% CI 0.97-2.29,P =0.07] and 12 months [OR =0.99,95% CI 0.70-1.39,P =0.93] among two groups.There was no significant difference in terms of PSM rate [OR =0.92,95 % CI 0.71-1.19,P =0.52] between BNP and non-BNP groups.Conclusions We found that preservation of the bladder neck result in earlier return of urinary continence without adversely affecting cancer control.

作者刘欣健文建国王庆伟王焱万有栋杨琨琨翟荣群

机构地区郑州大学第一附属医院尿动力学中心和泌尿外科郑州大学第一附属医院重症监护中心

出处《中华泌尿外科杂志》 CAS CSCD 北大核心 2016年第3期174-178,共5页 Chinese Journal of Urology

关键词前列腺肿瘤根治性前列腺切除术膀胱颈控尿功能切缘阳性率 Prostatectomy Urinary incontinence Bladder neck Prostatic neoplasms

分类号 R737.25 [医药卫生—肿瘤]

引文网络
相关文献

参考文献20

1XylinasE, PloussardG, DurandX, et al. Evaluation of combined oncological and functional outcomes after radical prostatectomy: trifecta rate of achieving continence, potency and cancer control-a Literature review[J].Urology, 2010, 76:1194-1198. DOI: 10.1016/j.urology.2010.03.096.
2WardJF, ZinckeH, BergstralhEJ, et al. The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy[J].J Urol, 2004, 172:1328-1332.
3WellsG, SheaB, O'ConnellD, et al. The Newcasstle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analysis[J/OL].Ottawa Hospital Research Institute Web site, 2012.[2015-07-1]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. DOI: 10.1007/s10096-015-2313-1.
4JadadAR, MooreRA, CarrollD, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17:1-12. DOI:10.1016/0197-2456(95)00134-4.
5FreireMP, WeinbergAC, LeiY, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes[J].Eur Urol, 2009, 56:972-980. DOI:10.1016/j.eururo.2009.09.017.
6LoweBA. Comparison of bladder neck preservation to bladder neck resection in maintaining postrostatectomy urinary continence[J].Urology, 1996, 48:889-893. DOI: http://dx.DOI.org/10.1016/S0090-4295(96)00324-X.
7IzadpanahiMH, HonarmandR, KhorramiMH, et al. A comparison of bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy[J].J Res Med Sci, 2014, 19:1140-1144.
8GakerDL, SteelBL. Radical prostatectomy with preservation of urinary continence: Pathology and long-term results[J].J Urol, 2004, 172:2549-2552.
9RaziA, YahyazadehSR, Sedighi GilaniMA, et al. Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence[J].Urol J, 2009, 6:23-26.
10StolzenburgJU, KallidonisP, HicksJ, et al. Effect of bladder neck preservation during endoscopic extraperitoneal radical prostatectomy on urinary continence[J].Urol Int, 2010, 85:135-138. DOI: 10.1159/000314842.

二级参考文献32

1Gronberg H. Prostate cancer epidemiology. Lancet, 2003, 361 : 859-864.
2Khoder WY, Trottmann M, Stuber A, et al. Early incontinence after radical prostatectomy: a community based retrospective analysis in 911 men and implications for preoperative counseling [ J/OL]. Urol Oncol, 2011 [2012-05-05 ]. http://dx, doi. org/ 10. 1016/j. urolonc. 2011. 10. 003. [ published online ahead of print November 21, 2011 ].
3McElveen TL, Waterman FM, Kim H, et al. Factors predicting for urinary incontinence after prostate brachytherapy. Int J Radiat Oncol Biol Phys, 2004, 59: 1395-1404.
4Stolzenburg J, Kallidonis P, Hicks J, et al. Effect of bladder neck preservation during endoscopic extraperitoneal radical pros- tatectomy on urinary continence. Urol Int, 2010, 85: 135-138.
5Sehuessler WW, Sehulam PG, Clayman RV, et al. Laparoseopic radical prostateetomy: initial short-term experience. Urology, 1997, 50 : 854-857.
6Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatec- tomy: description of technique and outcomes. Eur Urol, 2009, 56 : 972-980.
7Parsons JK, Marschke P, Maples P, et al. Effect of methylpred- nisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology, 2004, 64: 987-990.
8Anastasiadis AG, Salomon L, Katz R, et al. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology, 2003, 62: 292-297.
9Carlsson S, Aus G, Bergdahl S, et al. The excess burden of side-effects from treatment in men allocated to screening for pros- tate cancer. The Goteborg randomised population-based prostate cancer screening trial. Eur J Cancer, 2011,47 : 545-553.
10Razi A, Yahyazadeh SR, Sedighi Gilani MA, et al. Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence. Urol J, 2009, 6 : 23-26.