上海交通大学学报(医学版)

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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

初菁菁,冶超,金雯,殷希   

  1. 浙江大学 医学院附属第一医院病案统计室,杭州 310003
  • 出版日期:2017-01-28 发布日期:2017-01-19
  • 作者简介:初菁菁(1989—),女,技师,硕士;电子信箱:lynn0502chu@163.com。
  • 基金资助:

    浙江省科技计划项目(2013C33122)

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

CHU Jing-jing, YE Chao, JIN Wen, YIN Xi   

  1. Department of Medical Record, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
  • Online:2017-01-28 Published:2017-01-19
  • Supported by:

    Major Science and Technology Projects of Zhejiang Province, 2013C33122

摘要:

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PubMed、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RevMan5.3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。

关键词: 机器人辅助, 腹腔镜, 前列腺切除, meta分析

Abstract:

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 were searched to collect the controlled studies on RALP for localized prostate cancer. Meta-analysis was applied using the Review Manager V5.3 software in accordance with the Cochrane Collaboration. Results · A total of 15 studies were identified, including 1 621 cases of RALP and 1 894 cases of LRP. 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] and transfusion rate[OR=0.44, 95% CI (0.25, 0.79), P=0.006] were lower in RALP. Moreover, RALP was associated with significantly improved outcomes in the postoperative urinary continence rate of 3-month, 6-month, 12- month[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]. But there were no significant differences between the two techniques in operation time, rate of positive surgical margins and complication (P>0.05). Conclusion · RALP showed benefits in terms of operative blood loss, transfusion rate as well as functional outcomes. Further studies of larger populations with a longer follow-up are needed to make any statement.

Key words: robotic-assisted, laparoscopic, prostatectomy, meta-analysis