【摘要】：目的:系統(tǒng)評價筋膜內(nèi)與筋膜間保留性神經(jīng)的前列腺癌根治術(shù)的療效,為臨床上手術(shù)治療局限性前列腺癌提供循證依據(jù)。方法:通過計算機(jī)系統(tǒng)檢索Pub Med、Web of Science、Embase、Cochrane library、CNKI和萬方數(shù)據(jù)庫,查找比較保留性神經(jīng)的筋膜內(nèi)前列腺癌根治術(shù)與筋膜間前列腺根治術(shù)的臨床對照研究相關(guān)文獻(xiàn),檢索時限均從建庫至2016年11月23日。按照納入和排除標(biāo)準(zhǔn),兩位評價者獨立對文獻(xiàn)進(jìn)行篩查、質(zhì)量評價和數(shù)據(jù)提取,采用Revman 5.3軟件進(jìn)行Meta分析。研究指標(biāo)包括手術(shù)時間、術(shù)中失血量、臨床輸血率、術(shù)后導(dǎo)尿管留置時間、切緣陽性率、術(shù)后生化無進(jìn)展率、尿控恢復(fù)率和性功能恢復(fù)率。結(jié)果:本Meta分析共納入6篇研究(2篇隨機(jī)對照試驗,4篇回顧性隊列研究),共納入前列腺癌患者1311例,其中筋膜內(nèi)切除組患者558例(A組),筋膜間切除組患者753例(B組)。研究發(fā)現(xiàn),筋膜內(nèi)組與筋膜間組在術(shù)后導(dǎo)尿管留置時間(WMD=-46.54,95%CI[-62.05,-31.02],P0.00001)、術(shù)后尿控恢復(fù)率(3-mo,6-mo,12-mo)和術(shù)后性功能恢復(fù)率(3-mo,6-mo,12-mo)方面差異有統(tǒng)計學(xué)意義,筋膜內(nèi)組明顯優(yōu)于筋膜間組。而在手術(shù)時間、術(shù)中失血量、臨床輸血率、切緣陽性率和術(shù)后生化無進(jìn)展率方面兩組無統(tǒng)計學(xué)差異。結(jié)論:兩種手術(shù)方式均取得了較好的治療效果,術(shù)后患者病情均得到有效控制。但相比筋膜間前列腺癌根治性切除術(shù),筋膜內(nèi)前列腺癌根治性切除術(shù)的患者術(shù)后尿控功能恢復(fù)情況及勃起功能恢復(fù)情況較好,且術(shù)后導(dǎo)尿管留置時間明顯縮短。考慮本Meta分析納入研究較少,病例數(shù)較少,故存在一定局限性,有必要開展和設(shè)計大樣本隨機(jī)對照研究來進(jìn)一步驗證此結(jié)果。
[Abstract]:Objective: to evaluate the curative effect of intrafascial and interfascial nerve preserving radical prostatectomy for local prostate cancer. Methods: Pub Med,Web of Science,Embase,Cochrane library,CNKI and Wanfang databases were searched by computer system to find the literature related to the clinical comparative study of radical resection of intrafascial prostate cancer and interfascial prostatectomy. The time limit for retrieval is from the construction of the database to November 23, 2016. According to the inclusion and exclusion criteria, the two evaluators independently screened the literature, evaluated the quality and extracted the data, and carried out Meta analysis with Revman 5.3 software. The parameters included operation time, blood loss during operation, clinical transfusion rate, postoperative catheter indwelling time, positive rate of incision margin, no progress rate of biochemistry after operation, recovery rate of urinary control and recovery of sexual function. Results: this Meta analysis included 6 studies (2 randomized controlled trials and 4 retrospective cohort studies), including 1311 patients with prostate cancer, including 558 patients with intrafascial resection (group A). There were 753 cases in interfascial resection group (group B). The time of catheter indwelling (WMD=-46.54,95%CI [-62.05- 31.02], P0.00001) and the recovery rate of urinary control (3-mo-6-mo.) were found in the intrafascial group and interfascial group. There was significant difference between 12-mo and postoperative sexual function recovery rate (3-mo-6-mo-12-mo). The intrafascial group was significantly better than the interfascial group. However, there was no significant difference between the two groups in the time of operation, the amount of blood lost during operation, the rate of clinical blood transfusion, the positive rate of incision margin and the rate of no progress in biochemistry after operation. Conclusion: the two kinds of operation methods have achieved better therapeutic effect, and the patients' condition has been effectively controlled after operation. But compared with radical resection of interfascial prostate cancer, the patients with radical resection of intrafascial prostate cancer had better recovery of urinary control function and erectile function after radical resection of intrafascial prostate cancer, and the postoperative indwelling time of catheter was shortened obviously. Considering the limited number of cases and the small number of cases in this Meta analysis, it is necessary to develop and design a large sample randomized controlled study to further verify the results.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.25

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