【摘要】：目的:評價經(jīng)腹膜途徑與經(jīng)腹膜外途徑行機器人輔助腹腔鏡根治性前列腺切除術(shù)治療局限性前列腺癌的療效和安全性。方法:采用計算機綜合檢索PubMed,the Cochrane Library,Web of Science,中國知網(wǎng)文獻(xiàn)數(shù)據(jù)庫(CNKI)、維普中文科技期刊全文數(shù)據(jù)庫、萬方數(shù)據(jù)庫中公開發(fā)表的文獻(xiàn),同時手工檢索圖書館內(nèi)相關(guān)內(nèi)容的期刊,檢索時間截止至2016年12月。由兩名本課題組的研究人員按照制定好的檢索策略以及納入、排除標(biāo)準(zhǔn)相互獨立進(jìn)行篩選并提取數(shù)據(jù),當(dāng)兩人意見存在分歧時,則通過討論達(dá)成共識或者請第三名研究人員參與評判。對符合標(biāo)準(zhǔn)的研究進(jìn)行質(zhì)量評價,并使用RevMan 5.3統(tǒng)計軟件進(jìn)行Meta分析。結(jié)果:本篇Meta分析共納入了8篇文獻(xiàn),其中2篇屬于隨機對照實驗,6篇是病例對照研究。共有1127例患者納入研究,其中采用E-RALRP 676例,采用T-RALRP451例。Meta分析結(jié)果顯示:E-RALRP組手術(shù)時間短于T-RALRP組(WMD,-19.22;95%CI,-28.70~-9.74;p0.0001);術(shù)中出血量在E-RALRP組與T-RALRP組之間差異無統(tǒng)計學(xué)意義(WMD,-8.84;95%CI,-45.68~27.99;p=0.64);對于切緣陽性率,E-RALRP組與T-RALRP組之間差異無統(tǒng)計學(xué)意義(OR,0.86;95%CI,0.61~1.20;p=0.37);E-RALRP組的住院時間較T-RALRP組更短(WMD,-0.65;95%CI,-1.25~-0.05;p=0.04);術(shù)后并發(fā)癥的發(fā)生率E-RALRP組比T-RALRP組少(OR,0.48;95%CI,0.32~0.72;p=0.0004);術(shù)后腸道并發(fā)癥的發(fā)生率E-RALRP組少于T-RALRP組(OR,0.13;95%CI,0.04~0.45;p=0.001);術(shù)后插導(dǎo)尿管時間在E-RALRP組與T-RALRP組之間差異無統(tǒng)計學(xué)意義(WMD,-0.19;95%CI,-0.98~-0.60;p=0.64);對于術(shù)后即刻、3個月以及6個月控尿功能的比較上E-RALRP組與T-RALRP組之間差異無統(tǒng)計學(xué)意義,其中刻控尿功能(OR,2.00;95%CI,0.57~7.08;p=0.28),3個月控尿功能(OR,1.59;95%CI,0.74~3.44;p=0.24),6個月控尿功能(OR,1.46;95%CI,0.58~3.70;p=0.43)。結(jié)論:經(jīng)腹膜外途徑行機器人輔助腹腔鏡根治性前列腺切除術(shù)在治療局限性前列腺癌是安全有效的,且在手術(shù)時間、住院天數(shù)、術(shù)后并發(fā)癥以及術(shù)后腸道并發(fā)癥指標(biāo)上比傳統(tǒng)經(jīng)腹膜途徑更能讓患者獲益,臨床上可以針對患者病情及醫(yī)療水平選擇最佳的術(shù)式。
[Abstract]:Objective: to evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy in the treatment of localized prostate cancer via peritoneal approach and extraperitoneal approach. Methods: a comprehensive computer search method was used to search the published articles in PubMeden the Cochrane Library Web of Science and Technology, CNKI, the full text database of Chinese scientific and technological journals in Weipu and Wanfang database, and to retrieve the journals of relevant contents in the library by hand at the same time. The search time is up to December 2016. Two researchers from our team sifted and extracted data independently of each other according to the established search strategy and inclusion criteria, and when the two people had different opinions, A consensus is reached through discussion or a third researcher is invited to participate in the judgment. The quality of the standard was evaluated and Meta-analysis was carried out with Revman 5.3 statistical software. Results: a total of 8 articles were included in this meta-analysis, of which 2 were randomized controlled trials and 6 were case-control studies. A total of 1127 patients were included in the study, of whom 676 were treated with E-RALRP. 閲囩敤T-RALRP451渚，

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