经腹腔与经腹膜后腹腔镜治疗上尿路尿路上皮癌疗效对比的meta分析

Meta-analysis of transabdominal versus retroperitoneal laparoscopic nephroureterectomy in the curative effect of upper urinary tract urothelial carcinoma

目的比较经腹腹腔镜肾输尿管切除术(TLNU)和经腹膜后腹腔镜肾输尿管切除术(RLNU)治疗上尿路尿路上皮癌患者的手术时间、术中出血量、术后胃肠功能恢复时间、术后住院时间和术后复发及转移情况。方法在中国知网(CNKI)、万方医学网、维普百科、PubMed、Embase、Cochrane library等数据库选取符合要求的TLNU和RLNU的比较研究。对文献进行筛选并评估,采用RevMan 5.3软件进行数据分析。结果共检索文献14篇,样本总量为1036例,其中TLNU组476例,RLNU组560例。2组患者术后住院时间、术后复发及转移情况比较,差异均无统计学意义(P>0.05);手术时间、术中出血量、术后胃肠功能恢复时间比较,差异均有统计学意义(P<0.05)。结论对上尿路尿路上皮癌患者采用TLNU治疗拥有更短的手术时间和更少的术中出血量,采用RLNU治疗拥有更短的术后胃肠功能恢复时间,二者术后住院时间、术后复发及转移情况无明显差异,两种术式具有各自的特征,临床医师可根据患者病情选择适合的手术入路方式。

Objective To compare the operation time,intraoperative blood loss,postoperative recovery time of gastrointestinal function,postoperative hospital stays,postoperative recurrence and metastasis of upper urinary tract urothelial carcinoma(UTUC)treated by transabdominal laparoscopic nephroureterectomy(TLNU)and retroperitoneal laparoscopic nephroureterectomy(RLNU).Methods Comparative studies of TLNU and RLNU in the Chinese databases including CNKI,Wanfang Data Platform and Wikipedia,while the English databases including PubMed,EMBASE and Cochrane Library were selected.After literature screening and evaluation,RevMan 5.3 software was used for data processing.Results A total of 14 articles were searched in Chinese and English databases,with a total sample of 1036 cases,including 476 cases in the TLNU group and 560 cases in the RLNU group.There was no significant difference in the postoperative hospital stay and postoperative recurrence and metastasis(P>0.05).There were significant differences in operation time,intraoperative blood loss and postoperative recovery time of gastrointestinal function(P<0.05).Conclusion For patients with UTUC,TLNU has a shorter operation time and less intraoperative blood loss,RLNU has a shorter postoperative gastrointestinal function recovery time.There is no significant difference in postoperative hospital stay and postoperative recurrence and metastasis.The two types of operation have their own characteristics,and clinicians can choose the appropriate surgical approach according to the patient′s condition.