腹腔镜与开放手术开展根治性膀胱切除术的Meta分析  

Comparison of laparoscopic and open radical cystectomy for bladder cancer: A Meta-analysis

作　　者：孟旭辉[1] 黄懿[1] 

机构地区：[1]南京医科大学第二附属医院泌尿外科,江苏南京210011

出　　处：《现代肿瘤医学》2014年第11期2653-2657,共5页Journal of Modern Oncology

基　　金：国家自然科学基金青年科学基金项目(编号:81300572);江苏省卫生厅指导性课题(编号:Z201303);江苏省自然科学基金面上项目(编号:BK2011860)

摘　　要：目的:评价腹腔镜(LRC)和开放手术(ORC)进行根治性膀胱切除术的近期效果的差异。方法:搜索中英文数据库Pubmed、EMBASE、Cochrane library、Sciencedirect、CNKI、Sinomed等,检索和筛选已发表的有关腹腔镜与开放手术进行根治性膀胱切除术的随机对照试验(RCT)以及非随机对照试验(NRCT),手术方式均为根治性全膀胱切除。对纳入研究进行质量评价、筛查,提取相关数据,STATA 11.0软件进行Meta分析。结果:纳入10篇文献,共678名患者。其中4篇中文文献,6篇外文文献。由于涉及伦理原因,均为回顾性NRCT文献。各研究间年龄、性别、BMI等基础资料未见统计学差异。Meta分析结果提示:LRC相比ORC,手术时间更长(P<0.0001),术中出血量少(P<0.0001),切缘阳性率低(P=0.014),淋巴结清扫数多(P=0.04),肠道恢复时间短(P<0.0001),住院时间短(P<0.0001),并发症发生率低(P=0.007),新膀胱容量无差异(P=0.704)。结论:在根治性全膀胱术的选择中,除手术时间外,LRC各项指标均优于ORC。鉴于临床RCT实验文献较少,仍需多中心、大样本、前瞻性的RCT实验,进行长期随访。Objective：To assess the short-term outcomes of laparoscopic radical cystectomy （LRC） and open radical cystectomy（ORC） on bladder cancer.Methods：We searched Pubmed,EMBASE,Cochrane library,Sciencedirect,CNKI and Sinomed to collect the worldwide application of LRC and ORC for bladder cancer of randomized controlled trials（RCT） and non-randomized controlled trials （NRCT）.The literatures were screened by quality assessment,from which the data extracted was used to complete the meta statistical analysis through STATA 11.0 software.Results：A total of 10 NRCTs involving 678 patients were included,4 Chinese literatures and 6 foreign language literatures.The baseline of these studies was consistent,as the analysis showed no statistical significant differences in age,gender and BMI.Meanwhile,compared with open surgery,laparoscopic surgery has shorter operative time（P 〈 0.0001）,less blood loss （P 〈 0.0001）,lower positive rate of margin （P =0.014）,more dissected lymph nodes （P =0.04）,shorter recovery time of intestinal function（P 〈 0.0001）,shorter hospital stays（P 〈 0.0001） and lower incidence of complications （P =0.007）.And the new bladder capacity of two groups was not significant different （P =0.704）.Conclusion：LRC is a better method than ORC except the operative time.However,such clinical trials are almost retrospective.Large prospective clinical RCT trials are needed for further assessment analysis,so as the long-term follow-up.

关 键 词：根治性全膀胱切除 腹腔镜手术 开放手术 META分析 

分 类 号：R737.14[医药卫生—肿瘤]