上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

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

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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