单孔与传统腹腔镜根治性肾切除术的系统评价

    Laparoendoscopic Single-Site Radical Nephrectomy Versus Conventional Laparoscopic Radical Nephrectomy: A Meta-Analysis

    • 摘要: 目的 对单孔腹腔镜与传统腹腔镜行根治性肾切除术的临床有效性及安全性进行系统评价。 方法 计算机检索PubMed、EMBASE、Cochrane图书馆和ISI Web of Knowledge,查找2014年10月前所有对比单孔腹腔镜和传统腹腔镜行根治性肾切除术的临床研究,采用RevMan 5.1软件进行Meta分析。 结果 共纳入了10篇回顾性和1篇前瞻性对照试验,551例患者。与传统腹腔镜相比,单孔腹腔镜手术时间较长(P<0.01),但术中出血量、术后疼痛评分和术后镇痛剂需要量较小,住院时间、术后恢复时间和禁食时间较短,外观满意度较优(P<0.01);手术并发症、转换率、术中输血率和肿瘤复发率等差异没有统计学意义(P>0.05)。 结论 单孔腹腔镜根治性肾切除术能取得与传统腹腔镜相近的疗效,且有术中出血少、术后恢复快和疼痛小的优势,患者满意度较高,有望在临床上得到广泛应用。

       

      Abstract: Objective To compare perioperative and postoperative outcomes of laparoendoscopic single-site (LESS-RN) radical nephrectomy and conventional laparoscopic radical nephrectomy (CL-RN). Methods PubMed, MEDLINE, EMBASE, ISI Web of Knowledge and Cochrane Library databases were searched for studies released prior to October 2014. References of included studies were also searched to identify additional and potentially relevant studies. And we analyzed the data using Review Manager (version 5.1). Results 10 retrospective comparative studies and 1 prospective comparative study were included, involving 551 patients. LESS-RN group showed longer operative time but lower estimated blood loss (EBL), VAS pain score and analgesics requirement. It also had shorter hospital stay and time to recover to diet (P<0.01). No significant difference was found in terms of complications, conversion, transfusion, incision length, Hb decrease, creatinine increase, negative margins and recurrence (P>0.05). Patients’ satisfaction was significantly better (P<0.01) in LESS-RN group. Condusion Laparoendoscopic single-site radical nephrectomy showed comparable outcomes to conventional laparoscopic radical nephrectomy, and it has less pain, blood loss and takes shorter to recover, showing advantages in patients’ satisfaction for cosmesis.

       

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