根治性前列腺切除术中保留膀胱颈对术后控尿功能恢复影响的Meta分析  

Urinary continence and pathological outcome after bladder neck preservation during radical prostatectomy： a systematic review and meta-analysis

作　　者：刘欣健 文建国[1] 王庆伟[1] 王焱[1] 万有栋[2] 杨琨琨[1] 翟荣群 

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,450052 [2]郑州大学第一附属医院重症监护中心,450052

出　　处：《中华泌尿外科杂志》2016年第3期174-178,共5页Chinese Journal of Urology

摘　　要：目的 系统评价根治性前列腺切除术中保留膀胱颈的安全性和有效性.方法 计算机检索PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献数据库、万方数据库中关于根治性前列腺切除术中保留膀胱颈和不保留膀胱颈的对比研究.检索时间均从建库至2015年7月.由2名评价员共同评价纳入研究的质量,采用RevMan 5.0软件对两种术式对术后控尿功能恢复、手术切缘阳性率的影响进行Meta分析.结果 共纳入12篇病例对照研究和2篇随机对照研究.共包括3 391例患者,其中2篇随机对照研究包含277例患者,12篇观察性研究包含3 114例患者（保留膀胱颈组1 985例,未保留膀胱颈组1 129例）.对12篇病例对照研究行Meta分析结果显示,保留膀胱颈组与未保留膀胱颈组比较,手术切缘阳性率[OR=0.92,95％ CI0.71 ～ 1.19,P=0.52],以及术后6个月[OR=1.49,95％ CI0.97 ～2.29,P=0.07]、12个月[OR =0.99,95％CI0.70～1.39,P=0.93]的控尿率差异均无统计学意义,但保留膀胱颈组术后1个月[OR =2.88,95％CI1.80 ～4.60,P ＜0.05]、3～4个月[OR =2.32,95％CI1.42 ～ 3.80,P＜0.05]的控尿率明显高于未保留膀胱颈组,差异均有统计学意义.结论 根治性前列腺切除术中保留膀胱颈有利于患者术后早期控尿功能的恢复,且不增加手术切缘阳性率.Objective To conduct a systematic review to evaluate efficacy and safety of bladder neck preservation techniques during radical prostatectomy.Methods We searched PubMed,Embase,Medline,Central （the Cochrane Library,Issue 1,2013）,CNKI,CBM from the inception to July 2015 for randomized or observational studies assessing the influence of preservation of bladder neck on the continence recovery and cancer control outcomes after radical prostatectomy.Two researchers evaluated the quality of included studies.A meta-analysis was conducted using Review Manager 5.0 software.Results Twelve observational and two randomized studies were analyzed.BNP group had a faster recovery of early continence than non-BNP group at 1 month[OR =2.88,95% CI 1.80-4.60,P 〈 0.05],3-4 months [OR =2.32,95% CI 1.42-3.80,P 〈 0.05].However there was no statistically significant difference in terms of continence rate at 6 months [OR =1.49,95% CI 0.97-2.29,P =0.07] and 12 months [OR =0.99,95% CI 0.70-1.39,P =0.93] among two groups.There was no significant difference in terms of PSM rate [OR =0.92,95 % CI 0.71-1.19,P =0.52] between BNP and non-BNP groups.Conclusions We found that preservation of the bladder neck result in earlier return of urinary continence without adversely affecting cancer control.

关 键 词：前列腺肿瘤 根治性前列腺切除术 膀胱颈 控尿功能 切缘阳性率 

分 类 号：R737.25[医药卫生—肿瘤]