【摘要】：目的：總結(jié)對(duì)側(cè)腎功能正常的T1b期腎癌患者行腎部分切除術(shù)和根治性腎切除術(shù)的療效差異，為臨床上T1b期腎癌患者在手術(shù)方式的選擇上提供循證學(xué)證據(jù)。 方法：首先采用電子與手工檢索對(duì)相關(guān)文獻(xiàn)進(jìn)行初檢，進(jìn)行電子檢索的數(shù)據(jù)庫(kù)有Pub med/Medlinedatabase、Cochrane圖書(shū)館、Embase、CNKI相關(guān)期刊論文、維普數(shù)據(jù)庫(kù)和萬(wàn)方數(shù)字化期刊群，并通過(guò)各種主流搜索引擎查找與之相關(guān)文獻(xiàn)。對(duì)所有文獻(xiàn)進(jìn)行嚴(yán)格的初步篩選，初選后獲取相關(guān)文獻(xiàn)全文，并采用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具對(duì)試驗(yàn)進(jìn)行評(píng)價(jià)。文獻(xiàn)數(shù)據(jù)由兩名研究者獨(dú)立提取，并采用RevMan5.1軟件進(jìn)行Meta分析。 結(jié)果：按照嚴(yán)格的納入標(biāo)準(zhǔn)，最終腎部分切除術(shù)和腎癌根治術(shù)療效和安全性比較的臨床對(duì)照研究文獻(xiàn)共6篇，總共納入15740例患者，腎部分切除術(shù)組1841例，腎癌根治術(shù)組13926例。Meta分析結(jié)果示：（1）在6個(gè)研究中有4個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年總的生存率的比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.02，95%CI=（0.94，1.12），P=0.00030.1，Z=0.54，腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年總生存率的差異無(wú)統(tǒng)計(jì)學(xué)意義。（2）在6個(gè)研究中有4個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年腫瘤特異性生存率比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.11，95%CI=（1.04，1.18），P=0.80＞0.1，Z=3.24，腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年腫瘤的特異性生存率的差異有統(tǒng)計(jì)學(xué)意義。（3）在6個(gè)研究中有2個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年無(wú)瘤生存率比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=0.67，95%CI=（0.19，2.4），，P=0.010.1，Z=0.61，認(rèn)為腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年無(wú)瘤生存率的差異無(wú)統(tǒng)計(jì)學(xué)意義。（4）在6個(gè)研究中有2個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后腫瘤轉(zhuǎn)移情況的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=0.21，95%CI=（0.18，0.51），P=0.76＞0.1，Z=3.38，認(rèn)為腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后轉(zhuǎn)移情況的差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：以上結(jié)果表明：兩種手術(shù)方式術(shù)后患者5年總的生存率、5年無(wú)瘤生存率差別無(wú)統(tǒng)計(jì)學(xué)意義；腎部分切除術(shù)組術(shù)后5年腫瘤特異性生存率優(yōu)于腎癌根治術(shù)組，腎部分切除術(shù)組比腎癌根治術(shù)組術(shù)后更容易合并腫瘤轉(zhuǎn)移。
[Abstract]:Objective: to summarize the difference between partial nephrectomy and radical nephrectomy in patients with stage T 1b renal carcinoma with normal contralateral renal function, and to provide evidence for the choice of surgical methods in patients with stage T 1b renal carcinoma. Methods: first of all, electronic and manual retrieval was used to check the related documents. The databases of electronic retrieval included Pub med/Medlinedatabase,Cochrane library, Embase,CNKI full text database of Chinese periodicals, Weipu database and Wanfang digital periodical group. And through a variety of mainstream search engines to find relevant literature. After the primary selection, the full text of the relevant literature was obtained, and the bias risk assessment tool recommended by Cochrane Cooperative Network was used to evaluate the experiment. The literature data were extracted independently by two researchers and Meta analysis was carried out with RevMan5.1 software. Results: according to the strict inclusion criteria, there were 6 clinical comparative studies on the efficacy and safety of the final partial nephrectomy and radical nephrectomy. A total of 15740 patients were included in the study, 1841 in the partial nephrectomy group. The results of Meta analysis showed that: (1) four of the 6 studies could extract the data from partial nephrectomy and radical nephrectomy on the overall 5-year survival rate. The RR=1.02,95%CI= (0.94m1.12), P0. 00030. 1 and ZX 0. 54 were obtained by statistical analysis of the combined data by RevMan5.1 software. There was no significant difference in 5-year overall survival rate between partial nephrectomy and radical nephrectomy for stage T 1b renal cell carcinoma. (2) four of the six studies could extract partial nephrectomy and radical nephrectomy. 5 year tumor-specific survival rate data, The RR=1.11,95%CI= (1.04m1.18), P0. 80 > 0. 1GZ 3. 24 were obtained by statistical analysis of the data by RevMan5.1 software. There was significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (3) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. (3) in 6 studies, two tests can be used to extract partial nephrectomy and radical nephrectomy. The relevant data of postoperative 5-year tumor-free survival rate, RR=0.67,95%CI= (0.19 ~ 2.4), P ~ (0.010. 1) ~ (Z) ~ (0.61), P ~ (0.010. 1) ~ (2 +) were obtained by statistical analysis of data by RevMan5.1 software. It is concluded that there is no significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (4) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. The relevant data of tumor metastasis after operation, RR=0.21,95%CI= (0.18 鹵0.51) and P _ (0.76) > 0.1 ~ (1) Z ~ (3. 38) were obtained by RevMan5.1 software. It is concluded that there is a significant difference between partial nephrectomy and radical nephrectomy in the treatment of stage T 1b renal cell carcinoma after operation. Conclusion: the above results indicate that there is no significant difference in 5-year overall survival rate and 5-year tumor-free survival rate between the two surgical methods. The 5-year tumor specific survival rate of partial nephrectomy group was better than that of radical nephrectomy group, and partial nephrectomy group was more likely to be associated with tumor metastasis than that of radical nephrectomy group.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R737.11

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 張海玲;閆喜軍;;干擾素研究進(jìn)展[J];動(dòng)物醫(yī)學(xué)進(jìn)展;2008年04期

2 楊保旺;岳中瑾;;ABCG2與腎癌干細(xì)胞的研究進(jìn)展[J];中華實(shí)用診斷與治療雜志;2008年11期

3 蔡大偉;陳曉楠;劉學(xué)峰;吳斌;;血管生成素-2及其受體Tie2在腎癌中的表達(dá)及與微血管密度的關(guān)系[J];中華實(shí)用診斷與治療雜志;2010年01期

4 張東軍;孫志堅(jiān);馬志俊;;腎綜合征出血熱血清單核細(xì)胞趨化蛋白-1、E-選擇素、細(xì)胞間黏附分子-1、γ-干擾素、白細(xì)胞介素-10變化的臨床意義[J];中華實(shí)用診斷與治療雜志;2010年01期

5 陳香麗;張王剛;郭建民;趙文利;張茵;雷平?jīng)_;朱尊民;;干擾素-γ對(duì)小鼠白血病細(xì)胞株FBL-3體外侵襲能力影響[J];中華實(shí)用診斷與治療雜志;2011年06期

6 康德英,王家良,洪旗,劉關(guān)鍵;臨床試驗(yàn)Meta分析中的異質(zhì)性評(píng)價(jià)研究[J];華西醫(yī)學(xué);2000年02期

7 楊生海;殷宏;劉永生;張杰;;干擾素-γ研究進(jìn)展[J];生物技術(shù)通報(bào);2010年08期

8 周旭毓,方積乾;Meta分析的常見(jiàn)偏倚[J];循證醫(yī)學(xué);2002年04期

9 李泉林,關(guān)宏偉,張秋萍,薛波,韓輝,王法鵬,薛軍;腎細(xì)胞癌保腎手術(shù)安全切除范圍的探討[J];中華泌尿外科雜志;2002年12期

本文編號(hào)：2351764