离断性机器人辅助、腹腔镜和开放肾盂成形术治疗成人肾盂输尿管连接处梗阻疗效的Meta分析

Comparing the safety and efficacy of robotic-assisted,laparoscopic and open dismembered pyeloplasty:a Meta-analysis

目的系统评价离断性机器人辅助肾盂成形术(robotic-assisted pyeloplasty,RP)、腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)和开放肾盂成形术(open pyeloplasty,OP)在治疗成人肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)中的有效性和安全性。方法系统性地在MEDLINE、Cochrane Central Register of Controlled Trials及Web of Science数据库检索文献,检索时间均从建库至2018年12月31日。提取纳入研究的信息和数据,使用Stata 14和RevMan 5.3软件进行Meta分析。结果共纳入13篇比较离断性RP和LP的研究(RP 349例,LP 322例),10篇比较离断性LP和OP的研究(LP 446例,OP 380例)及1篇比较三者的研究。LP与OP相比有相似的成功率(OR=0.89,95%CI 0.47~1.69,P=0.729)和并发症发生率(OR=0.89,95%CI 0.58~1.36,P=0.585),LP有更长的手术时间(WMD=53.86,95%CI 13.23~94.29,P=0.009)和更短的住院时间(WMD=-2.32,95%CI-3.48^-1.16,P<0.001)。RP与LP相比有较高的成功率(OR=2.53,95%CI 1.03~6.19,P=0.043)、较低的并发症发生率(OR=0.54,95%CI 0.31~0.96,P=0.034)、较短的手术时间(WMD=-25.94,95%CI-47.56^-4.23,P=0.019)和住院时间(WMD=-1.06,95%CI-1.89^-0.23,P=0.012)。结论离断性RP较LP在成功率、并发症发生率、手术时间和住院时间方面有一定的优势,若将来能解决其昂贵的费用问题,其可作为治疗成人UPJO的常规选择方法。

Objective This systematic review and Meta-analysis was conducted to clarify the safety and efficacy of robotic-assisted(RP),laparoscopic(LP)and open(OP)dismembered pyeloplasty.Methods A systematic literature search on MEDLINE,Cochrane Central Register of Controlled Trials,and Web of Science was conducted to identify the relevant studies published before December 2018.Information was extracted from each eligible article.All statistical analyses of this Meta-analysis were performed with Stata 14 and RevMan 5.3 software.Results A total of 24 studies met the inclusion criteria and were included in this Meta-analysis.Compared with OP,LP showed similar results on success rate(OR=0.89,95%CI 0.47-1.69,P=0.729)and complication rate(OR=0.89,95%CI 0.58-1.36,P=0.585).LP had a longer operative time(WMD=53.86,95%CI 13.23-94.29,P=0.009)and shorter length of stay(WMD=-2.32,95%CI-3.48--1.16,P<0.001).Our study found that RP was superior to LP with respect to success rate(OR=2.53,95%CI 1.03-6.19,P=0.043),complication rate(OR=0.54,95%CI 0.31-0.96,P=0.034),operative time(WMD=-25.94,95%CI-47.56--4.23,P=0.019)and length of stay(WMD=-25.94,95%CI-47.56--4.23,P=0.019).Conclusions RP has some advantages,it may be applied for UPJO routinely in the future if the costs can be decreased.