输尿管下段癌行根治术和部分切除术疗效对比的Meta分析  

A Meta-analysis of prognosis after radical nephroureterectomy and partial ureterectomy in the treatment of urothelial carcinoma of distal ureter

作　　者：吴梦华[1] 宋健[1] 赵继懋[1] 丰琅[1] 张道新[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《现代泌尿外科杂志》2016年第10期776-781,共6页Journal of Modern Urology

摘　　要：目的旨在研究输尿管部分切除术和肾输尿管全长切除术在治疗输尿管下段恶性肿瘤中的预后疗效对比。方法检索PubMed、MEDLINE、EMBASE and Cochrane中(1990年1月到2016年1月)关于输尿管恶性肿瘤行输尿管部分切除术和肾输尿管全长切除术的病例对照研究,共9篇文献纳入本次研究。数据提取后使用RevMan 5.2行Meta分析,使用随机或固定效应模型来计算OR值及95%可信区间(CI)。异质性分析使用I^2检验分析。结果本研究纳入的9项病例-对照研究,共4 798例患者。分为输尿管部分切除组PU和肾输尿管全长切除术组RNU。经过Meta分析表明,整体上RNU在上尿路输尿管肿瘤治疗的5年生存率(OR=0.84,95%CI=0.71~0.98,P=0.03)要高于PU,差异有显著性统计学意义;对输尿管恶性肿瘤位置进行进一步分析,发现下段恶性肿瘤患者术后5年生存率(OR=0.94,95%CI=0.76~1.15,P=0.53)在两组间无统计学差异;输尿管复发或再发率(OR=1.08,95%CI=0.68~1.71,P=0.74)及膀胱肿瘤复发率(OR=0.98,95%CI=0.58~1.68,P=0.95)两组间无明显统计学差异。结论输尿管部分切除术在治疗输尿管下段恶性肿瘤中与肾输尿管全长切除术疗效相当。Objective To compare the postoperative outcomes of partial ureterectomy （PU） and radical nephroureterec- tomy with bladder cuff removal （RNU） in the treatment of distal ureteral carcinoma. Methods Databases including PubMed, MEDLINE, EMBASE and Cochrane were searched for papers on the efficacy of PU and RNU published during Jan. 1990 and Jan. 2016. Data extracted were analyzed using classic Meta-analysis with RevMan 5.2. The random or fixed effect model analysis was used to estimate odd ratios （OR） and 95% confidence intervals （CI）. Heterogeneity was described using 12 statistic. Results A total of 9 papers involving 4 798 patients were included. Patients were divided into the PU group and RNU group. Meta-analysis showed the 5-year survival of patients with upper urinary tract carcinoma was higher in the RNU group than in the PU group （OR = 0.84, 95 ～ CI=0. 71～0.98, P= 0.03）. There were no statistical differences in the 5-year survival of patients with lower urinary tract carcinoma （OR=0.94, 95% CI = 0.76～ 1.15, P = 0.53）, bladder recurrence （OR =0.98, 95%CI=0.58-1.68, P=0.95） and ureter recurrence （OR= 1.08, 95%CI=0.68～1.71,P=0.74）. Conclusion Partial ureterectomy is an effective surgical method for the patients with distal ureteral carcinoma.

关 键 词：输尿管肿瘤 肾输尿管全长切除术 输尿管部分切除术 生存率 肿瘤复发 META分析 

分 类 号：R737.1[医药卫生—肿瘤]