腹腔镜行根治性膀胱切除术安全性及有效性的meta分析

Meta-analysis of efficacy and safety after laparoscopic resection for bladder cancer

目的:评价腹腔镜膀胱癌手术的安全性和近期疗效。方法:检索1999年起到目前已发表的有关比较腹腔镜(LR)和开放手术(OR)行根治性膀胱切除术的临床疗效和安全性的前瞻性随机对照试验研究的有关文献,并根据其中数据进行Meta分析。结果:最后有7项RCT纳入分析,腹腔镜组与开放组患者一般情况无明显差异。腹腔镜组手术出血量较开放组减少180.1mL,但手术时间相对延长31.4min。切除肿块体积较开放手术减少18.3cm3。切缘情况和清扫淋巴结数量两组比较无差异不显著。腹腔镜组术后常见并发症如尿漏、肺部感染及切口感染均低于开放手术组;术后发生肾积水、泌尿系感染、电解质紊乱、深静脉血栓和肿瘤转移复发两组无统计学差异;平均住院时间比开放组少4.5天。术后3年生存率无明显差异。结论:腹腔镜下行膀胱癌根治性切除术是安全可靠的,可以达到根治切除的目的。

Objective To investigate the curative effect and safety of laparoscopic radical cystectomy. Methods We retrieved articles of randomized controlled trials, which are published after 1999 and related to the analysis between the effects and safety of LR and open resection of radical cystectomy. We then extract data and did Meta analysis. Results 7 articles were included in the Meta analysis. There is no difference on the general characteristics between the two groups.Compared with the OR group, the blood loss was less by 180.1ml, however, the operation time was 31.4min more than the other group. The volume of resected specimen was 18. 3cm3 in LR group rather than OR group. There were no significant differences in the number of retrieved lymph nodes,and the rates of urine leakage and incision infection is less in LR group. In addition, there were no significant differ-ences in the rates of hydronephrosis, urinary tract infection, electrolyte disorder, deep venous thrombosis, cancer recurrence and cancer metastases. Moreover, LR group has hospital stay time 4.5days less than OR group. The mortality rate 3 years in LR group was as same as that in OR group. Conclusions LR is as safe and effective as OR, in radical cystectomy,and do less injure to patients.