【摘要】：目的：總結(jié)對側(cè)腎功能正常的T1b期腎癌患者行腎部分切除術(shù)和根治性腎切除術(shù)的療效差異，為臨床上T1b期腎癌患者在手術(shù)方式的選擇上提供循證學(xué)證據(jù)。 方法：首先采用電子與手工檢索對相關(guān)文獻(xiàn)進(jìn)行初檢，進(jìn)行電子檢索的數(shù)據(jù)庫有Pub med/Medlinedatabase、Cochrane圖書館、Embase、CNKI相關(guān)期刊論文、維普數(shù)據(jù)庫和萬方數(shù)字化期刊群，并通過各種主流搜索引擎查找與之相關(guān)文獻(xiàn)。對所有文獻(xiàn)進(jìn)行嚴(yán)格的初步篩選，初選后獲取相關(guān)文獻(xiàn)全文，并采用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險(xiǎn)評價(jià)工具對試驗(yàn)進(jìn)行評價(jià)。文獻(xiàn)數(shù)據(jù)由兩名研究者獨(dú)立提取，并采用RevMan5.1軟件進(jìn)行Meta分析。 結(jié)果：按照嚴(yán)格的納入標(biāo)準(zhǔn)，最終腎部分切除術(shù)和腎癌根治術(shù)療效和安全性比較的臨床對照研究文獻(xiàn)共6篇，總共納入15740例患者，腎部分切除術(shù)組1841例，腎癌根治術(shù)組13926例。Meta分析結(jié)果示：（1）在6個(gè)研究中有4個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年總的生存率的比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.02，95%CI=（0.94，1.12），P=0.00030.1，Z=0.54，腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年總生存率的差異無統(tǒng)計(jì)學(xué)意義。（2）在6個(gè)研究中有4個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年腫瘤特異性生存率比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=1.11，95%CI=（1.04，1.18），P=0.80＞0.1，Z=3.24，腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年腫瘤的特異性生存率的差異有統(tǒng)計(jì)學(xué)意義。（3）在6個(gè)研究中有2個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后5年無瘤生存率比較的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=0.67，95%CI=（0.19，2.4），，P=0.010.1，Z=0.61，認(rèn)為腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后5年無瘤生存率的差異無統(tǒng)計(jì)學(xué)意義。（4）在6個(gè)研究中有2個(gè)試驗(yàn)可以提取腎部分切除術(shù)和腎癌根治術(shù)關(guān)于術(shù)后腫瘤轉(zhuǎn)移情況的相關(guān)數(shù)據(jù)，經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得RR=0.21，95%CI=（0.18，0.51），P=0.76＞0.1，Z=3.38，認(rèn)為腎部分切除術(shù)和腎癌根治術(shù)治療T1b期腎癌術(shù)后轉(zhuǎn)移情況的差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：以上結(jié)果表明：兩種手術(shù)方式術(shù)后患者5年總的生存率、5年無瘤生存率差別無統(tǒng)計(jì)學(xué)意義；腎部分切除術(shù)組術(shù)后5年腫瘤特異性生存率優(yōu)于腎癌根治術(shù)組，腎部分切除術(shù)組比腎癌根治術(shù)組術(shù)后更容易合并腫瘤轉(zhuǎn)移。
[Abstract]:Objective: to summarize the difference between partial nephrectomy and radical nephrectomy in patients with stage T 1b renal carcinoma with normal contralateral renal function, and to provide evidence for the choice of surgical methods in patients with stage T 1b renal carcinoma. Methods: first of all, electronic and manual retrieval was used to check the related documents. The databases of electronic retrieval included Pub med/Medlinedatabase,Cochrane library, Embase,CNKI full text database of Chinese periodicals, Weipu database and Wanfang digital periodical group. And through a variety of mainstream search engines to find relevant literature. After the primary selection, the full text of the relevant literature was obtained, and the bias risk assessment tool recommended by Cochrane Cooperative Network was used to evaluate the experiment. The literature data were extracted independently by two researchers and Meta analysis was carried out with RevMan5.1 software. Results: according to the strict inclusion criteria, there were 6 clinical comparative studies on the efficacy and safety of the final partial nephrectomy and radical nephrectomy. A total of 15740 patients were included in the study, 1841 in the partial nephrectomy group. The results of Meta analysis showed that: (1) four of the 6 studies could extract the data from partial nephrectomy and radical nephrectomy on the overall 5-year survival rate. The RR=1.02,95%CI= (0.94m1.12), P0. 00030. 1 and ZX 0. 54 were obtained by statistical analysis of the combined data by RevMan5.1 software. There was no significant difference in 5-year overall survival rate between partial nephrectomy and radical nephrectomy for stage T 1b renal cell carcinoma. (2) four of the six studies could extract partial nephrectomy and radical nephrectomy. 5 year tumor-specific survival rate data, The RR=1.11,95%CI= (1.04m1.18), P0. 80 > 0. 1GZ 3. 24 were obtained by statistical analysis of the data by RevMan5.1 software. There was significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (3) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. (3) in 6 studies, two tests can be used to extract partial nephrectomy and radical nephrectomy. The relevant data of postoperative 5-year tumor-free survival rate, RR=0.67,95%CI= (0.19 ~ 2.4), P ~ (0.010. 1) ~ (Z) ~ (0.61), P ~ (0.010. 1) ~ (2 +) were obtained by statistical analysis of data by RevMan5.1 software. It is concluded that there is no significant difference between partial nephrectomy and radical nephrectomy in the treatment of T1b stage renal cell carcinoma. (4) two of the 6 studies can extract partial nephrectomy and radical nephrectomy. The relevant data of tumor metastasis after operation, RR=0.21,95%CI= (0.18 鹵0.51) and P _ (0.76) > 0.1 ~ (1) Z ~ (3. 38) were obtained by RevMan5.1 software. It is concluded that there is a significant difference between partial nephrectomy and radical nephrectomy in the treatment of stage T 1b renal cell carcinoma after operation. Conclusion: the above results indicate that there is no significant difference in 5-year overall survival rate and 5-year tumor-free survival rate between the two surgical methods. The 5-year tumor specific survival rate of partial nephrectomy group was better than that of radical nephrectomy group, and partial nephrectomy group was more likely to be associated with tumor metastasis than that of radical nephrectomy group.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R737.11

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