新型倒刺缝线在腹腔镜下肾部分切除术中的疗效及安全性的荟萃分析

Efficacy and safety of self-retaining barbed suture in the laparoscopic partial nephrectomy:meta-analysis

目的:系统评价新型倒刺缝线与普通缝线在腹腔镜下肾部分切除术(LPN)中应用的疗效及安全性,为临床选择提供循证依据。方法:制定检索策略计算机分别检索PubMed、Medline、Cochrane Central Register of Controlled Trials、维普、万方、中国生物医学文献数据库、中国科学引文数据库(CSCD)及中国期刊全文数据库(CNKI)。手工检索:中华泌尿外科杂志、临床泌尿外科杂志、现代泌尿外科杂志、微创泌尿外科杂志4种杂志。检索时间均从建库至2017年4月。检索国内外有关新型倒刺缝线与普通缝线在LPN中应用疗效的临床对照研究,按Cochrane系统评价方法提取资料,由2名评价员对纳入文献的质量进行评价,采用RevMan 5.3统计软件进行统计分析。结果:共纳入13篇临床对照研究,中文11篇,外文2篇,共包括1 100例患者,其中新型倒刺缝线566例,普通缝线534例。Meta分析结果显示:2种缝线在肿瘤直径(MD=0.01,95%CI:0.08~0.09,P=0.81)方面差异无统计学意义,但在肾脏热缺血时间(MD=-4.99,95%CI:-6.11^-3.86,P<0.00001)、手术时间(MD=-6.61,95%CI:-10.30^-2.93,P=0.0004)、R.E.N.A.L.评分(MD=0.32,95%CI:0.08~0.55,P=0.008)、术后并发症发生率(MD=0.49,95%CI:0.26~0.92,P=0.03)、术中出血量(MD=-9.54,95%CI:-18.08^-1.00,P=0.03)及术后住院时间(MD=-0.35,95%CI:-0.69^-0.01,P=0.04)等方面比较差异有统计学意义。结论:LPN中,与普通缝线相比,新型倒刺缝线在肾脏热缺血时间、手术时间、术中出血量、术后并发症及术后住院时间等方面具有明显优势。但鉴于纳入文献有限,关于新型倒刺缝线与普通缝线在LPN中应用的疗效及安全性有待于多中心、高质量的随机对照试验进一步验证。

Objective：To evaluate the efficacy and safety of self-retaining barbed suture and traditional suture in the application of laparoscopic partial nephrectomy（LPN）,provide confirmation basis for clinical selection.Method：We compiled literature on controlled clinical researches using self-retaining barbed suture and traditional suture in the application of LPN published in China and abroad.The retrieval time are built from the library until April 2017.The article search was performed by two independent reviewers.The following databases were searched：PubMed,Medline and the Cochrane Central Register of Controlled Trials,VIP,WanFang,Chinese biomedical literature database,Chinese science citation database（CSCD）and Chinese journal full-text database（CNKI）.Result：Participants included 13 clinical control studies,11 articles in Chinese,2 in foreign language including 1 100 patients（self-retaining barbed suture 566 cases and 534 cases of traditional suture）.Meta-analysis results showed that two kinds of stitches in tumor diameter（MD=0.01,95%CI：0.08-0.09,P=0.81）has no statistical difference,but in the kidney warm ischemia time（MD=-4.99,95%CI：-6.11^-3.86,P0.0001）,operation time（MD=-6.61,95%CI：-10.30^-2.93,P=0.0004）,P.E.N.A.score（MD=0.32,95%CI：0.08-0.55,P=0.008）,the incidence of postoperative complications（MD=0.49,95%CI：0.26-0.92,P=0.03）,intraoperative blood loss（MD=-9.54,95%CI：-18.08--1.00,P=0.03）and postoperative length of hospital stay（MD=-0.35,95%CI：-0.69--0.01,P=0.04）in aspect and so on has significant statistical difference.Conclusion：LPN using self-retaining barbed suture showed superiorities in kidney warm ischemia time,operation time,intraoperative blood loss,postoperative complications and postoperative length of hospital stay,etc.compared with using traditional suture.However,more multicenter,high-quality randomized controlled trials are needed for further verification in efficacy and safety of LPN using self-retaining barbed suture and traditional suture because of the limitation in the literature.