本文選題：腹膜外 + 機(jī)器人��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:采用Meta分析的方法比較經(jīng)腹途徑機(jī)器人輔助腹腔鏡根治性前列腺切除術(shù)(transperitoneal robot-assisted laparoscopic radical prostatectomy,Tp-RALRP)與經(jīng)腹膜外途徑機(jī)器人輔助腹腔鏡根治性前列腺切除術(shù)(extraperitoneal robot-assisted laparoscopic radical prostatectomy,Ep-RALRP)治療前列腺癌的臨床療效及安全性。方法:通過(guò)計(jì)算機(jī)檢索Pub Med,EMBASE,EBSCO,Cochrane library,萬(wàn)方(Wan fang),中國(guó)知網(wǎng)(CNKI),中國(guó)生物醫(yī)學(xué)數(shù)據(jù)庫(kù)(CBM)數(shù)據(jù)庫(kù)中所有對(duì)比Tp-RALRP與Ep-RALRP療效及安全性的臨床研究,上述所有數(shù)據(jù)庫(kù)的檢索年限均為自2000年1月~2016年11月,同時(shí)輔以手工檢索泌尿外科及男科方面的有關(guān)雜志。按照預(yù)先設(shè)定的文獻(xiàn)納入及排除標(biāo)準(zhǔn),兩位研究人員獨(dú)立對(duì)所檢索到的文獻(xiàn)進(jìn)行篩選,并對(duì)最終所納入的研究進(jìn)行質(zhì)量評(píng)價(jià)及數(shù)據(jù)提取,最后對(duì)各項(xiàng)結(jié)局指標(biāo)(手術(shù)時(shí)間、術(shù)中出血量、術(shù)后臥床時(shí)間、術(shù)后胃腸功能恢復(fù)時(shí)間、術(shù)后留置尿管時(shí)間、圍手術(shù)期并發(fā)癥發(fā)生率、與腸道有關(guān)的并發(fā)癥發(fā)生率、術(shù)后病理切緣陽(yáng)性率、術(shù)后尿道吻合口瘺發(fā)生率、術(shù)后不同時(shí)期控尿率)進(jìn)行Meta分析。統(tǒng)計(jì)學(xué)軟件采用Cochrane協(xié)作網(wǎng)提供的Rev Man5.3。結(jié)果:通過(guò)各數(shù)據(jù)庫(kù)初步檢索到的文獻(xiàn)有224篇,Pub Med檢索出36篇,EMBASE檢索出88篇,EBSCO檢索出70篇,Cochrane library檢索出9篇,CNKI檢索出6篇,wanfang檢索出9篇,CBM檢索出6篇文獻(xiàn),按照預(yù)先設(shè)定的納入及排除標(biāo)準(zhǔn),經(jīng)仔細(xì)篩選后共有8篇文獻(xiàn)納入該研究,包括2個(gè)隨機(jī)對(duì)照研究及6個(gè)非隨機(jī)對(duì)照臨床試驗(yàn),其中Tp-RALRP組451例,Ep-RALRP組676例。Tp-RALRP與Ep-RALRP相比,在手術(shù)時(shí)間(WMD=21.39,95%CI 7.54~35.24,P=0.002)、術(shù)后臥床時(shí)間(WMD=0.4,95%CI 0.25~0.56,P=0.01)、圍手術(shù)期并發(fā)癥發(fā)生率(OR=1.93,95%CI 1.30~2.87,P=0.001)、與腸道有關(guān)的并發(fā)癥發(fā)生率(OR=10.45,95%CI 3.42~31.92,P0.0001)、拔除尿管后即刻控尿率(OR=0.63,95%CI 0.42~0.95,P=0.03)、術(shù)后3月控尿率(OR=0.36,95%CI 0.13~0.98,P=0.05)等方面差異具有統(tǒng)計(jì)學(xué)意義。兩種手術(shù)方式在術(shù)中出血量(WMD=16.34,95%CI-24.81~57.50,P=0.44)、術(shù)后留置尿管時(shí)間(WMD=0.19,95%CI-0.60~0.98,P=0.64)、術(shù)后胃腸功能恢復(fù)時(shí)間(WMD=0.14,95%CI-0.35~0.63,P=0.57)、術(shù)后病理切緣陽(yáng)性率(OR=1.31,95%CI 0.93~1.85,P=0.12)、術(shù)后尿道吻合口瘺發(fā)生率(OR=0.98,95%CI 0.43~2.20,P=0.95)以及術(shù)后6月控尿率(OR=0.79,95%CI 0.11~5.66,P=0.81)等方面均無(wú)明顯差異。結(jié)論:與Tp-RALRP相比,Ep-RALRP具有手術(shù)時(shí)間短、術(shù)后臥床時(shí)間短、圍手術(shù)期并發(fā)癥發(fā)生率低、與腸道有關(guān)的并發(fā)癥發(fā)生率低、拔除尿管后即刻控尿率高、術(shù)后3月控尿率高等優(yōu)點(diǎn),因此,Ep-RALRP可能是手術(shù)治療前列腺癌更好的方法。但未來(lái)仍然需要開(kāi)展更多多中心、大樣本量、隨訪時(shí)間長(zhǎng)的隨機(jī)對(duì)照試驗(yàn)進(jìn)而更好地評(píng)估兩種手術(shù)方式的優(yōu)劣。
[Abstract]:Objective: to compare transperitoneal robot-assisted laparoscopic radical prostatectomyy Tp-RALRPs with transperitoneal robot-assisted laparoscopic radical prostatectomyy Ep-RALRPs by Meta-analysis. Clinical efficacy and safety of prostate cancer. Methods: all the clinical studies on the efficacy and safety of Tp-RALRP and Ep-RALRP were searched by computer in Pub Medus EMBASE EBSCOCOchrane libraryary, Wan Fang Fang Fang, CNKII, China Biomedical Database (CBM). All of the above databases were searched from January 2000 to November 2016, and the related journals of urology and andrology were searched by hand. According to the pre-set criteria for literature inclusion and exclusion, the two researchers independently sifted the retrieved literature, evaluated the quality of the final research and extracted the data, and finally evaluated the outcome indicators (operative time). The amount of blood lost during operation, the time of bed rest, the time of recovery of gastrointestinal function, the time of indwelling urinary catheter, the incidence of complications in perioperative period, the incidence of complications related to intestinal tract, the positive rate of pathological margin after operation, The incidence of postoperative urethral anastomotic fistula and the rate of urinary control at different stages after operation were analyzed by meta-analysis. The statistical software was provided by Rev Man5.3 by Cochrane collaboration. Results: a total of 224 papers were preliminarily retrieved from each database. 36 articles were retrieved from EMBASE, 88 articles were retrieved from EMBASE, 70 articles were retrieved from library, 9 articles were retrieved from library, 6 articles were retrieved from library, 9 articles were retrieved from EMBASE, and 6 articles were retrieved from EMBASE. According to the pre-set inclusion and exclusion criteria, a total of 8 articles were selected and included in the study, including two randomized controlled trials and six non-randomized controlled clinical trials. Among them, 451 cases in Tp-RALRP group were compared with Ep-RALRP group in 676 cases. Tp-RALRP was compared with Ep-RALRP. 鍦ㄦ墜鏈椂闂，

本文編號(hào)：2014317