经腹腔镜术与开放手术治疗嗜铬细胞瘤疗效比较的Meta分析  

A Meta-analysis of the efficacy of laparoscopy versus adrenalectomy for patients with pheochromocytoma

作　　者：王伟[1] 张杰[1] 周晓光[1] 王浩[1] 许明伟[1] 

机构地区：[1]武汉大学人民医院泌尿外科,430060

出　　处：《中华临床医师杂志（电子版）》2012年第18期123-127,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：中央高校基本科研业务费资助(20103020201000196);湖北省自然科学基金(2008CDA054)

摘　　要：目的系统评价经腹腔镜术与开放手术治疗嗜铬细胞瘤的疗效比较。方法采用计算机检索TheCochraneLibrary、PubMed、CNKI、CBM、万方等全文数据库中有关经腹腔镜术与开放手术治疗嗜铬细胞瘤的随机对照试验,同时检索纳入文献的参考文献。检索时限均为建库至2012年3月。由3名研究者根据GRADE系统推荐分级方法,对纳入研究的质量进行严格评价和资料提取,对符合质量标准的纳入研究进行Meta分析。统计学分析采用RevMan5.1和GRAED profiler软件。结果共纳入回顾性病例对照分析研究9篇,累计试验组病例145例,对照175例。Meta分析经两种术式治疗嗜铬细胞瘤的6个主要结局指标显示,经腹腔镜术切除嗜铬细胞瘤相比于开放性手术,在手术时间[WMD=-37.10,95%CI(-54.23,-19.98),P<0.0001]、术中出血量[WMD=-246.43,95%CI(-294.98,-197.87),P<0.0001]、血压、心率急剧波动例数[OR=0.22,95%CI(0.12,0.43),P<0.00001]、术后下床活动时间[WMD=-2.75,95%CI(-3.53,-1.96),P<0.00001]、术后住院时间[WMD=-2.77,95%CI(-3.49,-2.05),P<0.00001]、术后恢复进食时间[WMD=-0.91,95%CI(-1.37,-0.46),P<0.0001]等各方面,腹腔镜术更优于开放手术。Meta分析结果显示差异均有统计学意义。五个结局GRADE等级评价均为低等级,推荐强度为弱推荐。结论在嗜铬细胞瘤患者的治疗中,腹腔镜手术相比开放手术具有手术时间短、出血少、危险系数小、恢复快的特点。但鉴于纳入的文献质量过低,且纳入研究较少,未控制混杂因素对结局的影响,故建议临床上谨慎使用,尚需开展大样本、多中心、规范科学的高质量随机对照试验,以对结果进行进一步验证。Objective To evaluate the effectiveness of laparoscopy versus adrenalectomy for patients with pheochromocytoma.Methods A systemic review was performed according to the Cochrane handbook for systematic reviews of interventions.We searched Pubmed,the Cochrane library,CNKI and Wanfang database to retrieve all the randomized controlled trials.The bibliographies of the included studies were searched,too.The duration of search was from the date of databases set upto March 2012.Three independent researchers evaluated the included studies using GRADE.The extracted data were analyzed by RevMan 5.1 and GRAED profiler.Results Nine retrospective case control studies involving 145 cases and 175 controls were included.Meta-analyses showed six outcomes of laparoscopy compared with adrenalectomy,there was statistical difference in the efficacy of laparoscopy for patients with pheochromocytoma,in terms of operation time[WMD=-37.10,95% CI(-54.23,-19.98),P<0.0001],blood lose during operation [WMD=-246.43,95% CI(-294.98,-197.87),P<0.0001],the number of patients with acute fluctuation in blood pressure and heart rate[WMD=-2.75,95% CI(-3.53,-1.96),P<0.00001],postoperative activity out of bed days[WMD=-2.75,95% CI(-3.53,-1.96),P<0.00001],postoperative hospital stay[WMD=-2.77,95% CI(-3.49,-2.05),P<0.00001],mean duration of gastrointestinal tract recover[WMD=-0.91,95% CI(-1.37,-0.46),P<0.0001],the laparoscopy team was better than adrenalectomy team.However,the nine outcomes were all of low quality in the GRADE system and weak recommendation.Conclusions In the treatment of patients with pheochromocytoma,peritoneal laparoscopic surgery is feasible and safe,with no increase in the operation risks compared with adrenalectomy.Due to the poor quality,limitations and no control of confounding factors of the included studies,a prudent choice was suggested;and more high-quality,large sample studies were needed.

关 键 词：嗜铬细胞瘤 腹腔镜检查 肾上腺切除术 META分析 

分 类 号：R736.6[医药卫生—肿瘤]