摘要
目的:采用Meta分析的方法比较经腹途径机器人辅助腹腔镜下根治性前列腺切除术(Tp-RALRP)与经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术(Ep-RALRP)治疗局限性前列腺癌的临床疗效。方法:通过计算机检索Pubmed,EMBASE,Web of science,EBSCO,Cochrane library,万方,中国知网(CNKI),中国生物医学数据库(CBM)(2000年1月~2016年11月),入选文献必须对比Tp-RALRP与Ep-RALRP的疗效,包含手术时间、术中出血量、术后留置导尿时间、术后卧床时间、围手术期并发症发生率、切缘阳性率、与肠道有关的并发症发生率、术后尿道吻合口瘘发生率、术后控尿率等指标中的至少一项,运用Meta分析方法比较两种手术方式在治疗局限性前列腺癌疗效上的差异。统计学软件采用Rev Man 5.3软件。结果:经仔细筛选后共有8篇文献纳入该研究,其中Tp-RALRP组451例,Ep-RALRP组676例。与Tp-RALRP相比,Ep-RALRP具有手术时间短(WMD=21.39,95%CI 7.54~35.24,P=0.002),术后卧床时间短(WMD=0.85,95%CI 0.61~1.09,P<0.001)、与肠道有关的并发症发生率低(RR=9.74,95%CI 3.26~29.07,P<0.001)等优势,差异均有统计学意义(P<0.05)。两种手术方式的术中出血量(WMD=-8.12,95%CI-27.86~11.63,P=0.42)、术后留置导尿时间(WMD=-0.17,95%CI-0.55~0.21,P=0.38)、围手术期并发症发生率(RR=1.34,95%CI-0.97~1.87,P=0.08)、切缘阳性率(RR=1.24,95%CI 0.95~1.61,P=0.12)、术后尿道吻合口瘘发生率(RR=0.98,95%CI 0.46~2.10,P=0.95)、术后3个月控尿率(RR=0.96,95%CI 0.91~1.00,P=0.05)及术后6个月控尿率(RR=1.00,95%CI 0.97~1.02,P=0.82)等方面差异均无统计学意义(P>0.05)。结论:与Tp-RALRP相比,Ep-RALRP具有手术时间短、术后卧床时间短、与肠道有关的并发症发生率低等优点,因此,Ep-RLRP可能是治疗局限性前列腺癌更好的方法。但未来仍然需要开展更多多中心、大样本的随机对照研究进而更好地评估两种手术方式的优劣。
Objective: To compare the clinical effects of transperitoneal (Tp) versus extraperitoneal (Ep) robot-assisted radical prostatectomy (HARP) in the treatment of localized prostate cancer. Methods : We searched PubMed, EMBASE, Web of Science, EBSCO, Cochrane Library, Wanfang, CNKI, and CBM for the articles comparing the clinical effect Tp-RARP with that of Ep-RARP in the treatment of localized prostate cancer published from January 2000 to November 2016. All the articles must meet the inclusion crite- ria, that is, dealing with at least one of the following aspects: operation time, intraoperative blood loss, postoperative catheterization time, length of bed confinement, perioperative complications, positive surgical margins, bowel-related complications, postoperative anastomotic leakage, and postoperative urinary continence. We subjected the data obtained to statistical analysis using the RevMan5.3 software. Results: Two randomized controlled trials and six case-control studies were included in this meta-analysis, involving 451 cases of Tp-RARP and 676 cases of Ep-RARP. Compared with Tp-RARP, Ep-RARP showed significantly shorter operation time (WMD = 21.39, 95% CI: 7.54-35.24, P = 0.002), shorter length of bed confinement (WMD = 0.85, 95% CI: 0.61- 1.09, P 〈 0.001 ), and lower rate of bowel-related complications ( RR = 9.74, 95% CI : 3.26 - 29.07, P 〈 0.001 ). However, no statistically significant differences were found between the two strategies in intraoperative blood loss (WMD = - 8. 12, 95% CI: -27.86 - 11.63, P --- 0.42) , postoperative catheterization time (WMD = 0.17, 95% CI: -0.55 -0.21, P = 0.38), or the rates of perioperative complications (RR = 1.34, 95% CI: -0.97 - 1.87, P = 0.08), positive surgical margins (RR = 1.24, 95% CI : 0.95 - 1.61, P = 0.12), anastomotic leakage ( RR = 0.98, 95% CI: 0.46 - 2.10, P = 0.95), urinary continence at 3 months (RR = 0.96, 95% CI: 0.91 -1.00, P = 0.05) and urinary continence at 6 months (RR = 1.00, 95% CI: 0.97 - 1.02, P = 0.82 ). Conclusion : Ep-RARP has the advantages of shorter operation time, shorter length of bed confinement and lower rate of bowel-related complications over Tp-RARP, and therefore may be a better option for the treatment of localized prostate cancer. However, more multi-centered randomized controlled clinical trials are needed for further evaluation of these two approaches.
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2017年第6期540-549,共10页
National Journal of Andrology
基金
兰州市人才创新创业项目(2015-RC-16)~~
关键词
机器人
前列腺癌
前列腺切除术
META分析
transperitoneal
extraperitoneal
robot-assisted radical prostatectomy
prostate cancer
prostatectomy
meta-analysis