腹腔镜下不阻断与全部阻断肾动脉肾部分切除术比较的Meta分析  

Comparison of curative effects between laparoscopic off-clamp and on-clamp renal artery in partial nephrectomy: a meta-analysis

作　　者：玉苏甫.艾比布力 拜合提亚.阿扎提 王文光[1] 安尼瓦尔.牙生[1] 王玉杰[1] Yusufu Aibibuli;Baihetiya·Azati;Wang Wenguang;Anniwaer-Yasheng;Wang Yujie(Department of Urology,the First Affliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外科,乌鲁木齐830054

出　　处：《中华腔镜泌尿外科杂志（电子版）》2019年第2期112-116,共5页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的比较腹腔镜下不阻断肾动脉肾部分切除术与全部阻断肾动脉肾部分切除术的安全性和疗效,并为肾部分切除术的手术方式选择提供理论依据。方法通过检索Pub Med,Embase,Chochranelibrary,Web of Scince,CNKI和万方等数据库,搜索腹腔镜下不阻断肾动脉肾部分切除术与全部阻断肾动脉肾部分切除术疗效比较的临床对照研究文献,检索时限均从建库至2017年10月31日。按照纳入和排除标准,筛查文献并质量评价和数据提取,并进行Meta分析。结果共13篇临床对照研究,共涉及肾部分切除术患者1 423例,其中不阻断肾动脉行肾部分切除术557例(不阻断组),肾动脉全部阻断行肾部分切除术866例(完全阻断组)。Meta分析结果显示:完全不阻断组与全部阻断组在肿瘤大小(P=0.03)、总并发症发生率(P=0.02)、术中失血量(P=0.001)方面差异有统计学意义,不阻断组肿瘤大小,总并发症发生率小于全部阻断组,不阻断组术中失血量多于全部阻断组;在手术时间(P=0.43)、术后住院时间(P=0.28)、切缘阳性率(P=0.56)、尿漏(P=0.27)、输血(P=0.92)等方面差异无统计学意义,而术后远期肾功能变化上差异有统计学意义(P=0.04),不阻断组肾功能丢失小。结论腹腔镜不阻断肾动脉肾部分切除术具有与肾动脉完全阻断术一样的安全性,而且在保护远期肾功能上具有优势。Objective To compare the safety and efficacy between laparoscopic off-clamp and on-clamp renal artery in partial nephrectomy.Method Systematic search of the electronic databases,including PubMed,Embase,Chochranelibrary,Web of Scince,CNKI and Wanfang Database(from the data of their establishments to November 2017).We retrieved the literatures about comparing laprascopic off-clamp and on-clamprenal artery in partial nephrectomy.At the same time,reference documents were involved by hand choice and given meta-analysis.Result A total of 13 controlled clinical studies were enrolled,including 1423 patients,of whom 557 cases were off-clamp group and the other 866 cases were on-clamp renal artery group.meta-analysis showed significant difference between on-clamp renal artery and off-clamp renal artery groups in tumor size(P=0.03),overall comparison rate(P=0.02)and estimated blood loss(P=0.001),off-clamp group with small tumor size,low comparison rate and larger blood loss.There is no significant difference operative time(P=0.43),length of stay(P=0.28),transfusion rates(P=0.92),urinary leaks(P=0.27),and positive surgical margins(P=0.65).Off-clamp group was associated with significance lower reduction in eGFR than on-clamp group.Conclusion In some criteria for tumor selection,compared with complete clamping of the ranal artery in partial nephrectomy,off-clamp renal artery partial nephrectomy can achieve the same effect.Moreover,off-clamp nephrectomy is better at renal function preservation.

关 键 词：腹腔镜 零缺血 肾部分切除术 META分析 

分 类 号：R737.11[医药卫生—肿瘤]