机器人辅助根治性前列腺切除术后耻骨上引流与经尿道引流比较的meta分析

Suprapubic tube drainage versus transurethral catheterization after robot-assisted radical prostatectomy:A systematic review and meta-analysis

目的:系统评价机器人辅助根治性前列腺切除术(RARP)后耻骨上引流(SPT)和经尿道引流(TUC)两种引流路径的安全性和有效性。方法:计算机检索Pub Med、EMBASE、The Cochrane Library(2017年12期)、中国期刊全文数据库(CNKI)、中国科技期刊数据库(VIP)、万方数据库(Wan Fang Data)和中国生物医学文献数据库(CBM),并辅助手工检索和其他检索,搜集关于RARP后SPT和TUC两种引流路径比较的随机对照试验和队列研究,检索时限均为建库至2017年12月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5. 3软件进行meta分析。结果:共纳入10个研究,包括1 248例RARP患者,其中SPT组482例,TUC组766例。meta分析结果显示,SPT组阴茎疼痛明显轻于TUC组[RR=0. 63,95%CI(0. 50～0. 80),P=0. 000 2]。两组整体疼痛[术后1～3 d:均数差(MD)=-0. 26,95%CI(-1. 34～0. 83),P=0. 64;术后6～7 d:MD=-0. 50,95%CI(-1. 54～0. 54),P=0. 34]、尿失禁[RR=0. 80,95%CI(0. 56～1. 15),P=0. 23]、尿路感染[RR=0. 63,95%CI(0. 20～1. 97),P=0. 42]、膀胱痉挛缩[RR=0. 77,95%CI(0. 39～1. 53),P=0. 45]、尿道狭窄[RR=1. 32,95%CI(0. 08～20. 7),P=0. 84]、吻合口狭窄[RR=0. 20,95%CI(0. 02～1. 79),P=0. 15]和尿潴留[RR=0. 93,95%CI(0. 43～2. 00),P=0. 85]差异均无统计学意义。结论:当前研究证据表明,SPT相比于TUC可以减轻患者阴茎疼痛,在其他方面两者没有差异。但受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究加以证实。

Objective： To compare the effectiveness and safety of suprapubic tube drainage （SPT） with those of transurethral catheterization （TUC） after robot-assisted radical prostatectomy （RARP）. Methods： We searched PubMed, EMBASE, Cochrane Library, CNKI, VIP, WanFang Data and China Biology Medicine Disc from their inception to December 2017 for randomized controlled trials and cohort studies comparing the effectiveness and safety of SPT and TUC after RARP. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies, followed by a recta-analysis with the RevMan 5.3 soft- ware. Results ： Ten studies met the eligibility criteria and were included in this recta-analysis, involving 1 248 cases of RARP, 482 in the SPT group and the other 766 in the TUC group. The severity of postoperative penile pain was significantly lower in the SPT than in the TUC group （ RR = 0.63, 95% CI ： 0.50 to 0.80, P = 0. 0002） , but no statistically significant differences were shown be- tween the two groups in the overall pain severity at 1-3 days （[MD = -0.26, 95% CI： -1.34 to0.83, P = 0.64] and6-7 days postoperatively （ [ MD = - 0.50, 95% CI： - 1.54 to 0.54, P = 0.34 ], urinary incontinence （RR = 0.80, 95% CI： 0.56 to 1.15, P = 0.23）, bacteriuria （RR = 0.63, 95% CI： 0.20 to 1.97, P = 0.42）, bladder neck contracture （RR = 0.77, 95% CI： 0.39 to 1.53, P = 0.45）, urethral stricture （RR = 1.32, 95% CI： 0.08 to 20.7, P = 0.84）, anastomotie stricture （RR = 0.20, 95% CI： 0.02tol.79, P = 0.15）, or urinary retention （RR = 0.93, 95% CI： 0.43 to 2.00, P = 0.85）. Conclu- sion ： SPT after RARP is associated with a lower severity of postoperative penile pain than TUC, but there are no statistically significant differences between the two strategies in other parameters. This conclusion, however, has to be further supported by more higher-quali- ty randomized controlled trials.