前列腺癌根治术中尿道后筋膜重建技术对尿控能力影响的荟萃分析

The influence of posterior reconstruction technique on continence during prostatectomy:a Metaanalysis

目的探讨前列腺癌根治术中尿道后筋膜重建技术对术后尿控的影响。方法检索Pubmed,Embase,Cochrane Library,Web of Science,CNKI和万方等数据库,查找比较前列腺癌根治术中尿道后筋膜重建和传统前列腺癌根治术后尿控能力的研究,检索时限均从建库至2018年1月31日。采用Review Manager 5.3软件进行Meta分析。结果共纳入22篇文献,其中随机对照研究有3篇,前瞻性观察研究有5篇,回顾性研究有14篇;共纳入的患者3594例,其中尿道后筋膜重建的患者2021例,标准前列腺癌根治术的患者1573例。拔出尿管后3~7 d、30 d、90 d、180 d尿控率,尿道后筋膜重建组优于标准手术组(OR=3.14,3.15,3.01,2.5;P<0.05);防止尿漏发生方面重建组优于标准手术组(OR=0.39,P<0.05);而拔出尿管后24 h尿控,切缘阳性率、急性尿潴留发生、吻合口狭窄发生率,勃起功能保护率两组间差异无统计学意义(OR=1.66,1.03,1.38,0.50,1.45;P>0.05)。结论前列腺癌根治术中尿道后筋膜重建可提高患者尿控早期恢复,还能减少尿漏发生,而在保证切缘阴性,急性尿潴留发生,吻合口狭窄等方面跟标准前列腺癌根治术一样具有安全性。

Objective To evaluate the influence of posterior musculofascial plate reconstruction on early return of continence after radical prostatectomy.Methods A systematic research of the electronic databases including Pubmed,Embase,Cochrane Library,Web of Scince,CNKI and Wanfang database(from the data of their establishments to January 2018)was given about studies which had compared early return of continence between posterior musculofascial plate reconstruction prostatectomy and conventional prostatectomy.A Meta-analysis was conducted using Review Manager 5.3 software.Results A total of 22 clinical studies were enrolled,including 3 randomised controlled trials,5 prospective studies and 14 retrospective studies.A total of 3594 patients,of whom 2021 were reconstruction group and the other 1573 were standard group.Reconstruction group is beneficial than standard group in 3-7 d,30 d,90 d,180 d continence(OR=3.14,3.15,3.01,2.5;P<0.05)and escaping urinary leakage(OR=0.39,P<0.05)after radical prostatectomy.There was no difference in 24 h continence,positive surgical margins,urinary retention,erectile function and bladder neck stricture(OR=1.66,1.03,1.38,0.50,1.45;P>0.05).Conclusions Reconstruction technique is benificial for urinary continence and escaping urinary leakage than standard prostotactomy,and has the same safty on positive surgical margins,urinary retention,erectile function and bladderneck stricture compared with standard prostatectomy.