开放手术对比腹腔镜手术治疗婴儿肾积水的Meta分析  

Meta-analysis of laparoscopic versus open pyeloplasty for infant hydronephrosis

作　　者：刘欣健 文雅[2] 文建国[1] 王庆伟[1] 王焱[1] 翟荣群 杨琨琨[1] 

机构地区：[1]郑州大学第一附属医院尿动力学中心和泌尿外科,河南郑州450052 [2]新加坡国立大学生物医学工程系,新加坡119077

出　　处：《现代泌尿外科杂志》2015年第10期696-700,共5页Journal of Modern Urology

基　　金：国家自然科学基金(No.81370869)

摘　　要：目的系统评价腹腔镜下肾盂成形术和开放手术治疗婴儿肾积水的有效性和安全性。方法计算机检索PubMed(1966至2015.4)、Cochrane Library(1996至2015.4)、Embase(1974至2015.4)、CNKI(1994至2015.4)、万方数据库(1989至2015.4)、CBM数据库(1978至2015.4),按照纳入和排除标准选择临床研究,评价纳入文献质量并提取资料,采用RevMan 5.2软件进行Meta分析。结果共纳入4篇病例对照研究,包括189例患者,其中腹腔镜下肾盂成形术组患者83例,开放肾盂成形术106例。Meta分析结果显示:两种手术方式手术成功比[OR=0.84,95%CI(0.19,3.71),P=0.81]、手术并发症[OR=1.26,95%CI(0.45,3.35),P=0.66]差异无统计学意义。腹腔镜下肾盂成形术组住院时间明显短于开放肾盂成形术组[WMD=2.10,95%CI(0.93,3.27),P=0.000 4],二者差异有统计学意义,但腹腔镜下肾盂成形术组手术时间明显长于开放肾盂成形术组[WMD=-68.07,95%CI(-123.02,-13.11),P=0.02],二者差异有统计学意义。结论腹腔镜下肾盂成形术治疗婴儿肾积水安全、有效,手术成功率和手术并发症与开放手术无明显差别,虽然增加了手术时间,但术后患者恢复快,明显减少患者住院时间。Objective To systematically evaluate the efficacy and safety of laparoscopic pyeloplasty（LP）versus open pyeloplasty（OP）for infant hydronephrosis.Methods Studies published up to April 2015 were identified from multiple databases,including PubMed,Cochrane Library,Embase,CNKI,Wanfang Database,and CBM.Only comparative studies investigating LP versus OP for infant hydronephrosis were included.Meta-analysis was performed using random-effects modeling.Heterogeneity and quality scoring were assessed.Effect sizes were estimated by pooled odds ratios and weighted mean differences.Primary outcomes investigated were operative success and postoperative complications.Secondary outcome measures were estimated operating time and length of hospital stay.Results A total of 4 observational studies met inclusion criteria,reporting outcomes of 106 OP and83 LP.No randomized controlled trial was identified.Pooled analysis determined no significant differences between LP and OP for operative success rate[OR=0.84,95%CI（0.19,3.71）,P=0.81]and postoperative complications[OR=1.26,95%CI（0.45,3.35）,P=0.66].The results of Meta-analysis showed that the operative time of OP was shorter than that of LP[WMD=-68.07,95% CI（-123.02,-13.11）,P=0.02],and the length of hospital stay of OP was longer than that of LP [WMD=2.10,95%CI（0.93,3.27）,P=0.000 04].Conclusions Existing evidence shows the efficiency and safety of LP and OP are similar.The operation time of OP was shorter and the length of hospital stay of LP was shorter.

关 键 词：婴儿 肾积水 腹腔镜手术 开放手术 META分析 系统评价 

分 类 号：R694.5[医药卫生—泌尿科学]