经腹与经后腹在腔镜下肾上腺切除术比较的Meta分析  

Meta-analysis of Transabdominal Versus Retroperitoneal Laparoscopic Adrenalectomy

作　　者：李阳明 杨逸冰 郝朋 曹亮 呼廷辉 蔡涛 崔曙[1] LI Yang-ming;YANY Yi-bing;HAO Peng;CAO Liang;HU Ting-hui;CAI Tao;CUI Shu(Department of Urology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Rheumatic immunology,the First People's Hospital of Yibin,Yibin 644000,Sichuan,China;Department of Urology,Emeishan City People's Hospital,Emeishan 614200,Sichuan,China)

机构地区：[1]川北医学院附属医院泌尿外科,四川南充637000 [2]宜宾市第一人民医院风湿免疫科,四川宜宾644000 [3]峨眉山市人民医院泌尿外科,四川峨眉山614200

出　　处：《医学信息》2023年第10期113-120,共8页Journal of Medical Information

摘　　要：目的探讨经腹与经后腹在腔镜下肾上腺切除术的疗效,为患者手术方式的选择提供科学依据。方法检索知网、万方、维普、PubMed、EMbase等中英文数据库,纳入符合研究需要的随机对照试验文献,通过Cochrane风险偏倚评估工具对文章质量进行评价,提取手术时间、术中估计出血量、术后下床时间、术后通气时间、术后住院时间、并发症发生率和中转开腹率,利用RevMan5.3及Stata 15.1进行Meta分析。结果共纳入中英文RCT文献共14篇,其中经腹组(TLA)共489例,经后腹组(RLA)共508例。Meta分析结果示,在手术时间、术中估计出血量、术后通气时间、术后住院时间方面,RLA组均优于TLA组,差异有统计学意义[WMD=9.71,95%CI(5.23,14.20)]、[WMD=9.18,95%CI(5.42,12.94)]、[WMD=7.90,95%CI(5.57,10.14)]、[WMD=1.28,95%CI(0.44,2.11)];在术后下床时间方面,TLA组与RLA组无明显差异[WMD=0.33,95%CI(-0.46,1.12),Z=0.82,P=0.413];在并发症发生率、中转开腹率方面,TLA组与RLA组无明显差异[RR=1.22,95%CI(0.77,1.95)]、[RR=1.37,95%CI(0.63,2.99)]。结论经后腹腔镜下肾上腺切除中的手术时间、术中估计出血量、术后通气时间、术后住院时间方面优于经腹腔镜下肾上腺切除,但在术后下床时间、并发症发生率、中转开腹率方面,两种手术入路无明显差异。Objective To investigate the efficacy of transabdominal and retroperitoneal laparoscopic adrenalectomy,and to provide a scientific basis for the choice of surgical methods.Methods CNKI,Wanfang,VIP,PubMed,EMbase and other Chinese and English databases were searched to include randomized controlled trials that met the needs of the study.The quality of the articles was evaluated by the Cochrane risk bias assessment tool.The operation time,estimated intraoperative blood loss,postoperative bed time,postoperative ventilation time,postoperative hospital stay,complication rate and conversion rate were extracted.Meta-analysis was performed using RevMan5.3 and Stata 15.1.Results A total of 14 Chinese and English RCT literatures were included,including 489 cases in transabdominal group(TLA)and 508 cases in retroperitoneal laparoscopic adrenalectomy group(RLA).The results of Meta-analysis showed that the RLA group was superior to the TLA group in terms of operation time,estimated intraoperative blood loss,postoperative ventilation time,and postoperative hospital stay,the difference was statistically significant[WMD=9.71,95%CI(5.23,14.20)],[WMD=9.18,95%CI(5.42,12.94)],[WMD=7.90,95%CI(5.57,10.14)],[WMD=1.28,95%CI(0.44,2.11)];there was no significant difference in postoperative ambulation time between TLA group and RLA group[WMD=0.33,95%CI(-0.46,1.12),Z=0.82,P=0.413];there was no significant difference in the incidence of complications and conversion rate between the TLA group and the RLA group[RR=1.22,95%CI(0.77,1.95)],[RR=1.37,95%CI(0.63,2.99)].Conclusion Retroperitoneal laparoscopic adrenalectomy is superior to laparoscopic adrenalectomy in terms of operation time,intraoperative estimated blood loss,postoperative ventilation time and postoperative hospital stay,but there is no significant difference between the two surgical approaches in terms of postoperative ambulation time,complication rate and conversion rate.

关 键 词：腹腔镜 肾上腺切除术 经腹 经后腹 

分 类 号：R699.3[医药卫生—泌尿科学]