摘要
目的 对经后腹膜腔途径与经腹腔途径腹腔镜下根治性肾切除术的相关文献进行Meta分析,以比较两种术式的安全性和疗效. 方法 检索2000年1月至2012年10月关于腹腔镜下根治性肾切除术的相关文献.国外文献选用Pubmed、Embase、Cochrane library数据库,以transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy为关键词.国内文献选用中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方中文数据库,以经腹腔、经后腹膜腔、根治性肾切除、腹腔镜作为关键词.由2名评价者共同评价纳入研究的质量,并采用Cochrane协作网提供的Revman 5.0统计软件对纳入文献进行Meta分析. 结果 共有9篇临床对照研究符合纳入标准,包括7篇国外文献和2篇中文文献,基线资料具有可比性.共纳入患者1 306例,其中经后腹膜腔途径组520例,经腹腔途径组786例.在手术时间（OR=16.23,95％CI 1.62～30.84）和术后并发症发生率（OR=2.44,95％CI 1.35 ～4.41）方面,经后腹膜腔途径显著优于经腹腔途径,差异均有统计学意义（P＜0.05）.在手术切口长度、术中出血量、住院时间、中转开放率、5年无复发生存率和5年总体生存率等方面两者比较差异均无统计学意义（P＞0.05）. 结论 经后腹膜腔途径腹腔镜下根治性肾切除术在手术时间和术后并发症方面显著优于经腹腔途径,但两种术式的疗效无显著差异,各中心可根据自身习惯选择手术方式.
Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy.Two researchers evaluated the quality of included studies.A meta-analysis was conducted using Review Manager 5.0 software.Results Nine controlled clinical studies were concluded,including 1 306 patients （520 in retroperitoneal group and 786 in transperitoneal group）.The extracted data were comparable.Meta-analysis results showed that significant difference existed in operative time and complication rate （OR =16.23,95% CI 1.62,30.84; OR =2.44,95%CI 1.35,4.41） （P〈0.05）.It seemed that the retroperitioneal laparoscopic radical nephrectomy was prior to the transperitoneal laparoscopic radical nephrectomy in those items.There was no significant difference between transperitoneal and retroperitioneal laparoscopic radical nephrectomy in incision length,estimated blood loss,stay-in hospital,conversion rate,5-year disease-free survival and 5-year overall survival （P〉 0.05）.Conclusions Retroperitoneal laparoscopic radical nephrectomy demonstrated significant lower operative time and complication rate than those in transperitoneal laparoscopic radical nephrectomy.However,there is no significant difference in efficacy.Each center can choose a modality according to their convention.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第5期326-329,共4页
Chinese Journal of Urology
