本文選題：前列腺癌　切入點(diǎn)：根治性前列腺切除術(shù)　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評價機(jī)器人輔助腹腔鏡前列腺癌根治術(shù)(RALP)與腹腔鏡前列腺癌根治術(shù)(LRP)兩種手術(shù)方式治療局限性前列腺癌的療效及安全性。 方法搜集世界范圍內(nèi)2000～2013年關(guān)于對比RALP與LRP兩種術(shù)式治療局限性前列腺癌的隨機(jī)對照試驗和非隨機(jī)對照試驗,并搜索納入研究文獻(xiàn)的參考文獻(xiàn)。計算機(jī)檢索PubMed、Ovid、ScienceDirect、EMBASE、CBM、中國知網(wǎng)文獻(xiàn)數(shù)據(jù)庫、維普及萬方等相關(guān)數(shù)據(jù)庫。手工檢索：檢索《中華泌尿外科雜志》、《中華腔鏡泌尿外科雜志》（電子版）、《臨床泌尿外科雜志》、《中華男科學(xué)雜志》、《中國男科學(xué)雜志》等國內(nèi)相關(guān)雜志（日期截止2013年12月）。根據(jù)納入/排除標(biāo)準(zhǔn)篩選文獻(xiàn)，兩位研究者獨(dú)立進(jìn)行文獻(xiàn)的篩選與提取，并交叉審核，當(dāng)出現(xiàn)分歧意見時，通過討論協(xié)商解決或者由第三方來決定。使用Rev-Man5.0軟件進(jìn)行Meta分析，并對手術(shù)時間、術(shù)中出血量、術(shù)后并發(fā)癥、術(shù)后控尿功能、輸血率、手術(shù)切緣陽性率及住院時間等指標(biāo)整理報道。 結(jié)果本篇Meta分析共納入了12篇文獻(xiàn)，共計6323例患者，其中行RALP術(shù)式的患者4461例，行LRP術(shù)式的患者1862例。Meta分析結(jié)果示：RALP手術(shù)時間短于LRP術(shù)式(WMD-19.36min，95%CI-35.44～-3.28min，P=0.02)，差異具有統(tǒng)計學(xué)意義。RALP術(shù)中出血量少于LRP(WMD-61.32ml，95%CI-120.22～-2.42ml，P=0.04)，差異具有統(tǒng)計學(xué)意義。LRP術(shù)后并發(fā)癥較少于RALP(OR2.09，95%CI1.20～3.64，P=0.009)，差異具有統(tǒng)計學(xué)意義。兩者術(shù)后一年控尿率RALP優(yōu)于LRP(OR1.95，95%CI1.41～2.71，P＜0.0001)，差異具有統(tǒng)計學(xué)意義�；颊邍中g(shù)期輸血率RALP與LRP之間差異無統(tǒng)計學(xué)意義(OR0.99，95%CI0.55～1.76，P＝0.96)。對于手術(shù)切緣陽性的發(fā)生率，RALP與LRP之間差異無統(tǒng)計學(xué)意義(OR1.08，95%CI0.76～1.52，P=0.67)。兩種術(shù)式住院時間之間差異無統(tǒng)計學(xué)意義(WMD-0.46，95%CI-1.08～0.16，P=0.15)。 結(jié)論對于局限性前列腺癌，機(jī)器人輔助腹腔鏡與腹腔鏡前列腺癌根治術(shù)的手術(shù)切緣陽性發(fā)生率、輸血率及住院天數(shù)相似。RALP的手術(shù)時間較LRP短，，術(shù)后一年控尿率、術(shù)中出血量都優(yōu)于LRP，但術(shù)后并發(fā)癥略多于LRP，但由于所需輸血量相對較少，以至于兩種術(shù)式患者的輸血率相似。兩種術(shù)式均為微創(chuàng)手術(shù)，都是治療局限性前列腺癌的安全有效的手段，由于納入研究的文獻(xiàn)可能存在發(fā)表偏倚，勢必對部分研究結(jié)果產(chǎn)生一定的影響，因此需要我們在以后的工作中收集更多質(zhì)量更高的文獻(xiàn)對二者進(jìn)行評價，為臨床工作提供堅實、可靠的證據(jù)。
[Abstract]:Objective to evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) in the treatment of localized prostate cancer. Methods A randomized controlled trial and a non-randomized controlled trial were collected from 2000 to 2013 to compare RALP and LRP in the treatment of localized prostate cancer. Search for references included in the research literature. Computer search for PubMedOvidgen Science Direction CBM, China Knowledge-based Literature Database, Databases related to Weip and Wanfang. Manual retrieval: retrieval of Chinese Journal of Urology, Chinese Journal of Endoscopic Urology (Electronic Edition, Journal of Clinical Urology), Chinese Journal of andrology, Chinese Journal of andrology, etc. Relevant domestic magazines (as of December 2013). Screening of literature according to inclusion / exclusion criteria, The two researchers independently selected and extracted documents and cross-examined them. When there were differences of opinion, they were resolved through discussion or decided by a third party. Meta analysis was conducted using Rev-Man5.0 software, and the time of operation and the amount of blood lost during the operation were analyzed. Postoperative complications, postoperative urinary control function, blood transfusion rate, surgical margin positive rate and hospital stay were reported. Results A total of 12 articles were included in this Meta analysis, including 4 461 patients who underwent RALP operation. The results of Meta-analysis of 1862 patients undergoing LRP operation showed that the time of WMD-19.36 min 95 CI-35.44 min -3.28 min P0. 02 was shorter than that of LRP procedure, the difference was statistically significant. The amount of bleeding during RALP operation was less than that of LRPU WMD-61.32 ml 95CI-120.22- 2.42 ml P0.04, the difference was statistically significant. The complications after LRP operation were less than that of RALPOR2.09CI1.203.64P0.009, and the difference was statistically significant. One year after operation, the urinary control rate of RALP was better than that of LRP OR 1.9595, CI 1.41C 2.71g P < 0.0001.There was no significant difference between RALP and LRP in perioperative period. There was no significant difference between RALP and LRP. There was no significant difference between RALP and LRP in the positive margin of operation. There was no significant difference in the length of hospitalization between the two types of operation (WMD-0.46 ~ 95CI-1.08 ~ 0.16). Conclusion for localized prostate cancer, the positive rate of surgical margin, the blood transfusion rate and the length of stay in the operation of robot-assisted laparoscopic and laparoscopic radical prostatectomy are shorter than those of LRP, and the rate of urine control in one year after operation is shorter than that of LRP. The amount of intraoperative bleeding was better than that of LRP, but the postoperative complications were slightly more than that of LRP, but the blood transfusion rate of the two operations was similar because of the relatively small amount of blood transfusion required. They are both safe and effective means for the treatment of localized prostate cancer. Due to the publication bias that may exist in the literature included in the study, it is bound to have a certain impact on some of the results of the study. Therefore, we need to collect more quality and higher literature to evaluate the two in future work, to provide solid and reliable evidence for clinical work.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.25

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 禹正楊,何生,李靜,李茂德;膽總管切開探查術(shù)后一期縫合膽管的評價(附6個隨機(jī)對照臨床試驗的meta分析)[J];中國實用外科雜志;2003年01期

2 江思艷;童九翠;孫瑞元;謝海棠;;復(fù)方丹參滴丸治療冠心病心絞痛Meta分析[J];實用藥物與臨床;2007年06期

3 賴真;姚燦坤;;燈盞細(xì)辛注射液治療急性腦梗死的meta分析[J];中國中醫(yī)急癥;2008年01期

4 楊潤濤;齊平;林智娟;;當(dāng)前大學(xué)生自我和諧狀況的分析[J];廣東藥學(xué)院學(xué)報;2008年04期

5 李江涌;陽中明;;文拉法辛治療抑郁癥對照研究的Meta分析[J];精神醫(yī)學(xué)雜志;2008年04期

6 賈俊;王子壽;周立;任振麗;;魚腥草注射液治療呼吸系統(tǒng)感染的效果分析[J];貴陽中醫(yī)學(xué)院學(xué)報;2009年05期

7 易湛苗;劉芳;翟所迪;;氟西汀治療腦卒中后抑郁有效性與安全性的系統(tǒng)評價(英文)[J];Journal of Chinese Pharmaceutical Sciences;2010年01期

8 劉穎;盧建秋;劉珍清;;清開靈注射液治療呼吸系統(tǒng)感染的Meta分析[J];中國醫(yī)院藥學(xué)雜志;2010年06期

9 龔平原;駱延;張科進(jìn);沈滟;;ADD1基因Gly460Trp位點(diǎn)與漢族人群原發(fā)性高血壓的Meta分析[J];河南科技大學(xué)學(xué)報(醫(yī)學(xué)版);2010年04期

10 靳蕊蕊;席亞明;晁榮;陳徹;;根除幽門螺桿菌治療特發(fā)性血小板減少性紫癜的Meta分析[J];第三軍醫(yī)大學(xué)學(xué)報;2011年17期

相關(guān)會議論文 前10條

1 李娟;田學(xué)豐;;潘托拉唑與其他藥物治療消化性潰瘍對照研究Meta分析[A];全國第三屆心腦血管疾病學(xué)術(shù)會議論文集[C];2003年

2 婁探奇;李超;石成鋼;陳珠江;唐驊;劉迅;;比較ACEI、ARB治療慢性腎臟病的Meta分析[A];“中華醫(yī)學(xué)會腎臟病學(xué)分會2004年年會”暨“第二屆全國中青年腎臟病學(xué)術(shù)會議”論文匯編[C];2004年

3 王毓洲;黃席珍;王菁;肖高輝;羅英;武永吉;;術(shù)治療阻塞性睡眠呼吸暫停綜合征文獻(xiàn)綜述及Meta分析[A];中國睡眠研究會第二屆學(xué)術(shù)年會論著匯編[C];2001年

4 劉利維;韓瑞發(fā);劉春雨;張衛(wèi);盧炳新;;保留腎單位手術(shù)和傳統(tǒng)腎癌根治術(shù)治療小腎癌療效比較的meta分析[A];第四屆中國腫瘤學(xué)術(shù)大會暨第五屆海峽兩岸腫瘤學(xué)術(shù)會議論文集[C];2006年

5 徐大志;詹友慶;李威;陳映波;孫曉衛(wèi);關(guān)遠(yuǎn)祥;李元方;;局部進(jìn)展期胃癌腹腔化療的Meta分析[A];第四屆中國腫瘤學(xué)術(shù)大會暨第五屆海峽兩岸腫瘤學(xué)術(shù)會議論文集[C];2006年

6 趙琛;穆敬平;楊玲;馬曉們;戚莉;;針灸治療腸易激綜合征的Meta分析[A];中國針灸學(xué)會2009學(xué)術(shù)年會論文集（上集）[C];2009年

7 龔芳紅;賀松;張德純;郭亞楠;;國內(nèi)益生菌制劑清除幽門螺桿菌感染臨床療效的Meta分析[A];重慶市預(yù)防醫(yī)學(xué)會2009年論文集[C];2009年

8 黃清水;;抗-CCP抗體對類風(fēng)濕關(guān)節(jié)炎診斷價值的Meta分析[A];第五次全國中青年檢驗醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];2006年

9 孫良;虞晨;王波;曹紅院;;我國胃癌發(fā)病主要危險因素的meta分析[A];全國腫瘤流行病學(xué)和腫瘤病因?qū)W學(xué)術(shù)會議論文集[C];2007年

10 沈朝斌;顧s

本文編號：1583924