经腹与经腹膜外途径腹腔镜前列腺癌根治术疗效比较的Meta分析

Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy: a Meta analysis

目的评价经腹膜外途径与经腹腔途径腹腔镜前列腺癌根治术治疗局限性前列腺癌的安全性和临床疗效。方法计算机检索Cochrane library、Pubmed、EMBASE、OVID、中国生物医学文献光盘数据库、中国期刊全文数据库、重庆维普数据库,搜集公开发表关于经腹膜外途径和经腹腔途径腹腔镜前列腺癌根治术临床疗效与安全性相比较的对照试验。采用Rev Man5.0软件进行统计分析。结果最后纳入12篇文献,受试患者共1329例,Meta分析结果显示:(1)经腹膜外途径组与经腹腔途径组相比较手术时间平均缩短21.75 min(WMD=-21.75,P<0.05)、进食时间平均缩短0.80 d(WMD=-0.80,P<0.05);(2)估计出血量(WMD=-18.89,P>0.05)、住院时间(WMD=-0.90,P>0.05)、术后切缘阳性率(OR=1.17,P>0.05)、术后漏尿(OR=1.37,P>0.05)、术后控尿率(OR=1.33,P>0.05)及术后吻合口狭窄(OR=1.97,P>0.05)两组差异无统计学意义。结论腹腔镜前列腺癌根治术经腹膜外途径与经腹腔途径相比较具有手术时间短、对腹腔器官影响小、术后胃肠道功能恢复快等优点。

Objective To evaluate the safety and clinical efficacy of laparoscopic radical prostatectomy by extraperitoneal approach （ELRP） and transperitoneal approach （TLRP） for the localized prostate cancer. Methods Computer retrieval of the controlled trials relating laparoscopic radical prostatectomy by extraperitoneal approach or transperitoneal approach for the localized prostate cancer in Cochrane Library （Issue3, 2012）, Medline Pubmed, EMBASE, CBMdisc, CNKI, and Chongqing VIP from January 1998 to October 2012. Meta analysis was performed by RevMan5.0. ~ Twelve literatures were enrolled in this study finally, a total of 1 329 localized prostate cancer patients. The Meta analysis results showed that： （1） Compared with the TLRP group, the operation time in the ELRP group decreased 21.75 min （WMD=-21.75, P〈0.05） and the time to diet decreased 0.80 days （WMD=-0.80, P〈0.05）; （2） There was no significant difference between the two groups in estimated blood loss （WMD=18.89,P〉0.05）, hospitalization time （WMD=- 0.90, P〉0.05）, positive surgical margin rate （OR=1.17,P〉0.05）, post-operative urine leakage （OR=1.37, P〉0.05）, post-operative urinary continence rate （OR=1.33, P〉0.05） and post-operative anastomotic stricture （ OR= 1.97, P〉0.05）. Conclusion In laparoscopic radical prostatectomy for the localized prostate cancer, extraperitoneal approach required shorter operation time, less impact on the abdominal organs, faster recovery of gastrointestinal function.