【摘要】：目的:采用Meta分析的方法比較經(jīng)腹途徑機(jī)器人輔助腹腔鏡下根治性前列腺切除術(shù)(Tp-RALRP)與經(jīng)腹膜外途徑機(jī)器人輔助腹腔鏡下根治性前列腺切除術(shù)(Ep-RALRP)治療局限性前列腺癌的臨床療效。方法:通過計(jì)算機(jī)檢索Pubmed,EMBASE,Web of science,EBSCO,Cochrane library,萬方,中國知網(wǎng)(CNKI),中國生物醫(yī)學(xué)數(shù)據(jù)庫(CBM)(2000年1月~2016年11月),入選文獻(xiàn)必須對比Tp-RALRP與Ep-RALRP的療效,包含手術(shù)時間、術(shù)中出血量、術(shù)后留置導(dǎo)尿時間、術(shù)后臥床時間、圍手術(shù)期并發(fā)癥發(fā)生率、切緣陽性率、與腸道有關(guān)的并發(fā)癥發(fā)生率、術(shù)后尿道吻合口瘺發(fā)生率、術(shù)后控尿率等指標(biāo)中的至少一項(xiàng),運(yùn)用Meta分析方法比較兩種手術(shù)方式在治療局限性前列腺癌療效上的差異。統(tǒng)計(jì)學(xué)軟件采用Rev Man 5.3軟件。結(jié)果:經(jīng)仔細(xì)篩選后共有8篇文獻(xiàn)納入該研究,其中Tp-RALRP組451例,Ep-RALRP組676例。與Tp-RALRP相比,Ep-RALRP具有手術(shù)時間短(WMD=21.39,95%CI 7.54~35.24,P=0.002),術(shù)后臥床時間短(WMD=0.85,95%CI 0.61~1.09,P0.001)、與腸道有關(guān)的并發(fā)癥發(fā)生率低(RR=9.74,95%CI 3.26~29.07,P0.001)等優(yōu)勢,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩種手術(shù)方式的術(shù)中出血量(WMD=-8.12,95%CI-27.86~11.63,P=0.42)、術(shù)后留置導(dǎo)尿時間(WMD=-0.17,95%CI-0.55~0.21,P=0.38)、圍手術(shù)期并發(fā)癥發(fā)生率(RR=1.34,95%CI-0.97~1.87,P=0.08)、切緣陽性率(RR=1.24,95%CI 0.95~1.61,P=0.12)、術(shù)后尿道吻合口瘺發(fā)生率(RR=0.98,95%CI 0.46~2.10,P=0.95)、術(shù)后3個月控尿率(RR=0.96,95%CI 0.91~1.00,P=0.05)及術(shù)后6個月控尿率(RR=1.00,95%CI 0.97~1.02,P=0.82)等方面差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:與Tp-RALRP相比,Ep-RALRP具有手術(shù)時間短、術(shù)后臥床時間短、與腸道有關(guān)的并發(fā)癥發(fā)生率低等優(yōu)點(diǎn),因此,Ep-RLRP可能是治療局限性前列腺癌更好的方法。但未來仍然需要開展更多多中心、大樣本的隨機(jī)對照研究進(jìn)而更好地評估兩種手術(shù)方式的優(yōu)劣。
[Abstract]:Objective: to compare the clinical efficacy of robot-assisted laparoscopic prostatectomy (Tp-RALRP) and retroperitoneal robotic-assisted laparoscopic prostatectomy (Ep-RALRP) in the treatment of localized prostate cancer by Meta analysis. Methods: we searched Pubmedus EMBASEN web of science (CNKI), Cochrane library, Wanfang, and (CNKI), Chinese biomedical database (CBM) (from January 2000 to November 2016. We must compare the efficacy of Tp-RALRP and Ep-RALRP, including operation time, intraoperative bleeding volume, postoperative indwelling time and indwelling catheterization time, among the selected documents, we should compare the efficacy of Tp-RALRP and Ep-RALRP, including the time of operation, the amount of blood lost during operation, and the time of indwelling catheterization after operation. At least one of the indexes included postoperative bed-rest time, perioperative complications, positive incisal margin, intestinal complications, postoperative urethral anastomotic fistula, postoperative urinary control rate, and so on. Meta analysis was used to compare the efficacy of the two surgical methods in the treatment of localized prostate cancer. The statistical software was Rev Man 5.3. Results: after careful screening, a total of 8 articles were included in the study, including 451 cases in Tp-RALRP group and 676 cases in Ep-RALRP group. Compared with Tp-RALRP, Ep-RALRP had the advantages of shorter operation time (WMD-21.39 / 95CI 7.5435. 24m P0.002), shorter bed-rest time (WMD-0.8595 CI 0.61CI-1.09p0.001) and lower incidence of intestinal complications (RRR9.795CI 3.262.077P0.001). The difference was statistically significant (P0.05). 涓ょ鎵嬫湳鏂瑰紡鐨勬湳涓嚭琛，

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