腹腔镜和开放手术膀胱癌根治术疗效比较的Meta分析  

A Meta-analysis between laparoscopic radical cystectomy and open radical cystectomy

作　　者：刘伟[1] 马振坤[1] 贺大林[1] 

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2014年第1期39-44,共6页Journal of Modern Urology

摘　　要：目的利用Meta分析的方法,评价腹腔镜膀胱癌根治术(LRC)与开放性膀胱癌根治术(ORC)两种手术方式治疗浸润性膀胱癌的疗效。方法选取发表于中国核心期刊及PubMed上的1990~2012年的文献,对比LRC与ORC两种术式治疗浸润性膀胱癌的临床对照试验,并应用Meta分析评价手术所需时间、手术过程中出血量、手术过程中输血情况、术后胃肠道恢复情况、术后患者住院时间、术后并发症、切缘阳性率、膀胱容量、膀胱内压、残余尿等相关指标。结果本篇Meta分析6篇临床同期对照试验。共纳入了597例患者,其中行LRC 336例患者,行ORC 261例患者。LRC手术所需时间(WMD34.87min,95%CI25.94~43.79min,P<0.000 01)长于开放手术,而LRC手术过程中出血量(WMD-506.61mL,95%CI-571.13^-442.09mL,P<0.000 01)、术中输血几率(OR0.20,95%CI0.11~0.38,P<0.000 01)均小于ORC,术后胃肠道恢复时间(WMD-2.12d,95%CI-2.20^-2.03d,P<0.000 01)、术后患者住院时间(WMD-4.99d,95%CI-5.79^-4.19d,P<0.000 01)、术后并发症发生率(OR0.30,95%CI0.18~0.48,P<0.000 01)均少于ORC。LRC术后手术切缘阳性率、新膀胱的膀胱容量、膀胱内压、残余尿与ORC组均无统计学差异。结论对于浸润性膀胱癌,LRC的手术时间长于ORC,但在减少术中出血量、缩短术后肠道功能恢复时间及术后住院时间、降低并发症发生率方面更优越。而腹腔镜与ORC的手术切缘阳性率及新膀胱功能相似。Objective To compare the outcomes of laparoscopic radical cysfectomy（LRC） and open radical cystectomy （ORC） in the treatment of invasive bladder cancer using Meta analysis. Methods We retrieved clinical trials comparing laparoscopic radical cystectomy with open radical cystectomy for invasive bladder cancer published from 1990 to 2012. And then we performed Meta analysis to evaluate the primary outcomes including operation time, operative blood loss, perioperative transfusion, restoration time to normal bowel function, hospital stay, incidence of complications, surgical margin status, bladder volume, intravesical pressure and residual urine. Results A total of 6 clinical controlled trials were enrolled in this analysis, including 597 patients, of whom 336 were treated with LRC and 261 with ORC. In the LRC group, the operation time was significantly longer than that in the ORC group （WMD 34.87 min, 95%CI 25.94 to 43.79 min,P〈0.000 01）. The LRC group experienced less operative blood loss （WMD-50661 mL, 95%CI-571.13 to -442.09 mL, P〈0.00001） and was less likely to receive a perioperative transfusion （OR 0.20, 95% CI 0.11 to 0.38, P〈0.00001）. In the LRC group, the restoration to normal bowel function （WMD-2.12 d, 95% CI-2.20 to -2.03 d,P〈0.000 01） and hospital stay （WMD-4.99 d, 95%CI-5.79 to - 419 d, P〈0.00001） were significantly shorter than those in the ORC group. LRC group experienced fewer complications （OR 030, 95%CI 0.18 to 0.48, P〈0.00001）. The differences in surgical margin status （OR 0.18, 95% CI 0.04 to 0.75, P=002）, the volume of neobladder （WMD 2.70 mL, 95% CI-5.87 to 11.28 mL, P=0.54）, the intravesical pressure of neobladder （WMD 0.12 cmH2O, 95%CI -1.33 to 1.58 cmH 2 O,P=0.87） and residual urine of neobladder （WMD 1.55 mL, 95%CI -164 to 4.74 mL

关 键 词：浸润性膀胱癌 膀胱癌根治术 腹腔镜 META分析 

分 类 号：R737[医药卫生—肿瘤]