本文選題：輸尿管鏡檢查 + 上尿路尿路上皮腫瘤　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探究在上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)根治術(shù)前行診斷性輸尿管鏡檢查(ureteroscopy,URS)是否對UTUC患者腫瘤復(fù)發(fā)及生存率產(chǎn)生影響。方法:檢索在中、英文公開發(fā)表的前瞻性或回顧性試驗(yàn),計(jì)算機(jī)檢索Pub Med、EMbase、Cochrane Library、萬方、中國知網(wǎng)數(shù)據(jù)庫,檢索時間從建庫至2017年2月1日,查找所有URS對UTUC腫瘤復(fù)發(fā)及生存率影響的前瞻性或回顧性研究,按納入、排除標(biāo)準(zhǔn)由兩人獨(dú)立進(jìn)行文獻(xiàn)納入、資料提取和質(zhì)量評價(jià)后,采用Cochrane協(xié)作網(wǎng)提供的Stata 12軟件進(jìn)行Meta分析。結(jié)果:共納入16個研究,包括7185例患者。對腫瘤無復(fù)發(fā)生存風(fēng)險(xiǎn)進(jìn)行多因素合并結(jié)果分析,由于所納入文章異質(zhì)性較大(I2=52.1%,P=0.010),考慮所納入文章對腫瘤復(fù)發(fā)位置缺少準(zhǔn)確的定位,對腫瘤復(fù)發(fā)位置進(jìn)行分層,由于相關(guān)文獻(xiàn)較少,無法進(jìn)行膀胱腫瘤復(fù)發(fā)及膀胱外腫瘤復(fù)發(fā)亞組分組,僅分為膀胱腫瘤復(fù)發(fā)亞組(I2=39.2%,P=0.097)及腫瘤復(fù)發(fā)亞組(包括腹膜后復(fù)發(fā),對側(cè)上尿路復(fù)發(fā)及膀胱復(fù)發(fā))(I2=16.4%,P=0.310),結(jié)果顯示術(shù)前行URS增加腫瘤無復(fù)發(fā)生存風(fēng)險(xiǎn)[HR=1.39,95%CI(1.17,1.66)],特別對于膀胱腫瘤復(fù)發(fā),行URS增加膀胱內(nèi)無復(fù)發(fā)生存風(fēng)險(xiǎn)[HR=1.60,95%CI(1.33,1.94)],單因素合并結(jié)果顯示行URS未增加腫瘤無復(fù)發(fā)生存風(fēng)險(xiǎn)[HR=1.11,95%CI(0.89,1.38)],但其中膀胱腫瘤復(fù)發(fā)亞組行URS增加膀胱內(nèi)無復(fù)發(fā)生存風(fēng)險(xiǎn)[HR=1.33,95%CI(1.07,1.67)];多因素合并結(jié)果顯示對于腫瘤特異生存期,行URS未增加腫瘤特異生存期的生存風(fēng)險(xiǎn)[HR=0.78,95%CI(0.60,1.62)],而單因素合并結(jié)果顯示行URS組優(yōu)于未行URS組[HR=0.69,95%CI(0.54,0.87)];行URS對總體生存風(fēng)險(xiǎn)沒有影響,單因素合并結(jié)果差異沒有統(tǒng)計(jì)學(xué)意義[HR=1.01,95%CI(0.63,1.62)]。結(jié)論:術(shù)前行URS增加腫瘤復(fù)發(fā)風(fēng)險(xiǎn),特別是膀胱腫瘤復(fù)發(fā),并未影響UTUC患者術(shù)后腫瘤特異生存期及總體生存風(fēng)險(xiǎn)。
[Abstract]:Objective: To explore the effect of diagnostic ureteroscopy (ureteroscopy, URS) on the recurrence and survival of UTUC patients before radical resection of upper tract urothelial carcinoma (UTUC). Methods: a prospective or retrospective study published in English, and a computer retrieval of Pub Med, EMbase, Cochr. Ane Library, Wanfang, China knowledge network database, search time from construction to February 1, 2017, look up all URS for UTUC tumor recurrence and survival rate of prospective or retrospective study. According to inclusion, the exclusion criteria are included by two people independently, after the data extraction and quality evaluation, the Stata 12 software provided by Cochrane collaboration network is used. Meta analysis. Results: a total of 16 studies, including 7185 patients, were included in the multiple factors analysis of the tumor free survival risk. Due to the larger heterogeneity of the articles (I2=52.1%, P=0.010), the lack of accurate location of the tumor recurrence location and the stratification of the tumor recurrence were considered, due to Xiang Guanwen Subgroups of bladder tumor recurrence and recurrence of bladder tumor recurrence were divided into subgroup of bladder tumor recurrence (I2=39.2%, P=0.097) and tumor recurrence subgroup (including retroperitoneal recurrence, retroperitoneal recurrence and bladder recurrence) (I2=16.4%, P=0.310), and URS increased the risk of tumor free survival [HR=1.39,95%CI before URS. (1.17,1.66), especially for the recurrence of bladder tumor, URS increased the risk of recurrence free survival in the bladder [HR=1.60,95%CI (1.33,1.94)]. The single factor combined results showed that URS did not increase the recurrence risk [HR=1.11,95%CI (0.89,1.38) of the tumor, but the recurrent subgroup of bladder tumor increased the risk of recurrence free survival in the bladder (0.89,1.38). 1.07,1.67)] the results of multi factor combination showed that URS did not increase the survival risk of tumor specific survival ([HR=0.78,95%CI (0.60,1.62)) for tumor specific survival period, and the single factor combined results showed that URS group was better than the non URS group [HR=0.69,95%CI (0.54,0.87)], and URS had no effect on the overall survival risk, and the single factor merger results had no difference. There was a statistically significant [HR=1.01,95%CI (0.63,1.62)] conclusion: URS increased the risk of tumor recurrence before operation, especially the recurrence of bladder tumor, which did not affect the tumor specific survival and overall survival risk of UTUC patients after operation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.1

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