机器人辅助与传统模式腹腔镜下前列腺根治性切除术的meta分析

Robotic-assisted versus laparoscopic radical prostatectomy: a meta-analysis

目的·系统评价机器人辅助腹腔镜下前列腺根治性切除术(RALP)和传统腹腔镜下前列腺根治性切除术(LRP)的疗效和术后功能恢复。方法·计算机检索Pub Med、Web of Science、Cochrane图书馆、EMbase、EBSCO、CINAHL、CNKI、万方、维普文献数据库,查找RALP相关的临床对照研究,采用国际Cochrane协作网推荐的Rev Man5.3软件进行系统评价。结果·最终纳入15篇文献,RALP组合计1 621人,LRP组合计1 894人。Meta分析结果显示:在前列腺根治性切除术方面,RALP较LRP能明显减少术中出血量[WMD=-120.29,95%CI(-182.20,-58.39),P=0.000 1]和降低输血率[OR=0.44,95%CI(0.25,0.79),P=0.006],术后第3、6、12个月的控尿率显著提高[OR=2.76,95%CI(1.99,3.82),P<0.000 01;OR=2.50,95%CI(1.72,3.63),P<0.000 01;OR=2.28,95%CI(1.51,3.46),P<0.000 1]。在手术时间、手术切口阳性率、术后并发症方面,RALP和LRP组之间差异无统计学意义(P>0.05)。结论·RALP在减少术中出血量和降低输血率方面有明显优势,术后功能恢复较好,远期疗效评价仍需要大规模长时间的随访研究数据。

Objective·To assess the outcomes of robotic-assisted laparoscopic prostatectomy(RALP)and laparoscopic radical prostatectomy(LRP).Methods·Databases including PubMed,Web of Science,Cochrane Library,EMbase,EBSCO,CINAHL,CNKI,WangFang and VIP Database weresearched to collect the controlled studies on RALP for localized prostate cancer.Meta-analysis was applied using the Review Manager V5.3softwarein accordance with the Cochrane Collaboration.Results·A total of15studies were identified,including1621cases of RALP and1894cases ofLRP.The results of meta-analysis showed that,compared to LRP,operative blood loss[WMD=-120.29,95%CI(-182.20,-58.39),P=0.0001]andtransfusion rate[OR=0.44,95%CI(0.25,0.79),P=0.006]were lower in RALP.Moreover,RALP was associated with significantly improved outcomesin the postoperative urinary continence rate of3-month,6-month,12-month[OR=2.76,95%CI(1.99,3.82),P<0.00001;OR=2.50,95%CI(1.72,3.63),P<0.00001;OR=2.28,95%CI(1.51,3.46),P<0.0001].But there were no significant differences between the two techniques in operation time,rate ofpositive surgical margins and complication(P>0.05).Conclusion·RALP showed benefits in terms of operative blood loss,transfusion rate as well asfunctional outcomes.Further studies of larger populations with a longer follow-up are needed to make any statement.