【摘要】：目的系統(tǒng)評(píng)價(jià)腹腔鏡腎部分切除術(shù)(LPN)與腹腔鏡冷凍消融術(shù)(LCA)治療小腎腫瘤(SRMs)的安全性及療效。方法計(jì)算機(jī)檢索Pub Med、SCI、Ovid、The Cochrane Library、CNKI、CBM、VIP及萬(wàn)方數(shù)據(jù)庫(kù),全面收集有關(guān)LPN與LCA比較治療SRMs的臨床對(duì)照試驗(yàn),檢索時(shí)限截至2016年4月。由2名評(píng)價(jià)者按照納入與排除標(biāo)準(zhǔn)選擇試驗(yàn)、提取資料和評(píng)價(jià)質(zhì)量后,采用Rev Man 5.3軟件進(jìn)行Meta分析。結(jié)果納入9篇研究,共748例患者。Meta分析結(jié)果顯示:LCA較LPN手術(shù)時(shí)間短[均數(shù)差(MD)=42.75,95%CI(12.19,73.31),P=0.006],術(shù)中出血量少[MD=190.73,95%CI(126.67,254.78),P=0.000],住院時(shí)間短[MD=2.23,95%CI(0.17,4.28),P=0.030],術(shù)式轉(zhuǎn)換率低[比值比(OR)=3.54,95%CI(1.18,10.59),P=0.020],并發(fā)癥少[OR=3.90,95%CI(1.84,8.24),P=0.000],術(shù)后腎小球?yàn)V過(guò)率(GFR)下降量低[MD=10.30,95%CI(5.38,15.24),P=0.000],局部復(fù)發(fā)風(fēng)險(xiǎn)高[OR=0.13,95%CI(0.04,0.44),P=0.000],遠(yuǎn)處轉(zhuǎn)移風(fēng)險(xiǎn)高[OR=0.16,95%CI(0.03,0.78),P=0.020],而在術(shù)后血肌酐(Scr)上升量、輸血率比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 LCA在圍手術(shù)期結(jié)果、保護(hù)腎功能方面更有優(yōu)勢(shì),但其有較高的腫瘤局部復(fù)發(fā)和遠(yuǎn)處轉(zhuǎn)移風(fēng)險(xiǎn),近期、中期療效相當(dāng),遠(yuǎn)期療效尚不明確,故在手術(shù)病例的選擇上仍需謹(jǐn)慎。
[Abstract]:Objective to evaluate the safety and efficacy of laparoscopic partial nephrectomy (LPN) and laparoscopic frozen ablation (LCA) in the treatment of small renal tumors. Methods to search the database of Pub Medtome, the Cochrane Library and the Wanfang database, and to collect the clinical controlled trials about the comparison of LPN and LCA in the treatment of SRMs. The retrieval time was up to April 2016. According to the inclusion and exclusion criteria, the two evaluators selected the test, extracted the data and evaluated the quality, and then carried out the Meta analysis with Rev Man 5.3 software. The results were included in 9 studies, 鍏，

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