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目的:采用Meta分析的方法比较经腹途径机器人辅助腹腔镜下根治性前列腺切除术(Tp-RALRP)与经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术(Ep-RALRP)治疗局限性前列腺癌的临床疗效。方法:通过计算机检索Pubmed,EMBASE,Web of science,EBSCO,Cochrane library,万方,中国知网(CNKI),中国生物医学数据库(CBM)(2000年1月~2016年11月),入选文献必须对比Tp-RALRP与Ep-RALRP的疗效,包含手术时间、术中出血量、术后留置导尿时间、术后卧床时间、围手术期并发症发生率、切缘阳性率、与肠道有关的并发症发生率、术后尿道吻合口瘘发生率、术后控尿率等指标中的至少一项,运用Meta分析方法比较两种手术方式在治疗局限性前列腺癌疗效上的差异。统计学软件采用Rev Man 5.3软件。结果:经仔细筛选后共有8篇文献纳入该研究,其中Tp-RALRP组451例,Ep-RALRP组676例。与Tp-RALRP相比,Ep-RALRP具有手术时间短(WMD=21.39,95%CI 7.54~35.24,P=0.002),术后卧床时间短(WMD=0.85,95%CI 0.61~1.09,P<0.001)、与肠道有关的并发症发生率低(RR=9.74,95%CI 3.26~29.07,P<0.001)等优势,差异均有统计学意义(P<0.05)。两种手术方式的术中出血量(WMD=-8.12,95%CI-27.86~11.63,P=0.42)、术后留置导尿时间(WMD=-0.17,95%CI-0.55~0.21,P=0.38)、围手术期并发症发生率(RR=1.34,95%CI-0.97~1.87,P=0.08)、切缘阳性率(RR=1.24,95%CI 0.95~1.61,P=0.12)、术后尿道吻合口瘘发生率(RR=0.98,95%CI 0.46~2.10,P=0.95)、术后3个月控尿率(RR=0.96,95%CI 0.91~1.00,P=0.05)及术后6个月控尿率(RR=1.00,95%CI 0.97~1.02,P=0.82)等方面差异均无统计学意义(P>0.05)。结论:与Tp-RALRP相比,Ep-RALRP具有手术时间短、术后卧床时间短、与肠道有关的并发症发生率低等优点,因此,Ep-RLRP可能是治疗局限性前列腺癌更好的方法。但未来仍然需要开展更多多中心、大样本的随机对照研究进而更好地评估两种手术方式的优劣。
OBJECTIVE: To compare the effects of transabdominal robot assisted laparoscopic radical prostatectomy (Tp-RALRP) and extraperitoneal robotic laparoscopic radical prostatectomy (Ep-RALRP) in the treatment of localized prostate The clinical efficacy of cancer. METHODS: Pubmed, EMBASE, Web of science, EBSCO, Cochrane library, CNKI and CBM (January 2000-November 2016) were searched by computer. To compare the efficacy of Tp-RALRP and Ep-RALRP, including operative time, intraoperative blood loss, postoperative catheterization time, postoperative bed rest time, perioperative complications, positive margins, and intestinal related Complications, the incidence of postoperative urethral anastomotic fistula, postoperative control of urine and other indicators of at least one of the use of meta-analysis of the two surgical methods in the treatment of localized prostate cancer differences in efficacy. Statistical software uses Rev Man 5.3 software. Results: After careful screening, a total of 8 articles were included in the study, including 451 cases of Tp-RALRP group and 676 cases of Ep-RALRP group. Compared with Tp-RALRP, Ep-RALRP had shorter operation time (WMD = 21.39, 95% CI 7.54-35.24, P = 0.002) and shorter bed time after treatment (WMD = 0.85, 95% CI 0.61-1.09, P < 0.001). The incidence of intestinal complications was lower (RR = 9.74, 95% CI 3.26-29.07, P <0.001). The difference was statistically significant (P <0.05). Intraoperative blood loss (WMD = -8.12, 95% CI-27.86 to 11.63, P = 0.42) and indwelling catheterization time (WMD = -0.17, 95% CI 0.55-0.21, P = 0.38). The incidence of perioperative complications (RR = 1.34, 95% CI -0.97 to 1.87, P = 0.08), positive margins (RR = 1.24, 95% CI 0.95-1.61, P = 0.12) The incidences of posterior urethral anastomotic fistula (RR = 0.98, 95% CI 0.46-2.10, P = 0.95), 3 months after operation (RR = 0.96,95% CI 0.91-1.00, P = 0.05) There was no significant difference in urine control rate (RR = 1.00, 95% CI 0.97 ~ 1.02, P = 0.82) after 6 months (P> 0.05). CONCLUSION: Ep-RALRP has the advantages of shorter operative time, shorter time to bed and lower incidence of complications associated with gut compared with Tp-RALRP. Therefore, Ep-RLRP may be better for the treatment of localized prostate cancer Methods. However, in the future, more multicenter, larger sample randomized controlled studies will be needed to better assess the pros and cons of the two surgical approaches.