筋膜内与筋膜间保留双侧神经的腹膜外腹腔镜前列腺癌根治术安全性和疗效的Meta分析

杨彬; 王靖宇; 王晋垚; 郭强; 张雁钢

doi:10.13201/j.issn.1001-1420.2017.09.010

筋膜内与筋膜间保留双侧神经的腹膜外腹腔镜前列腺癌根治术安全性和疗效的Meta分析

- 山西医学科学院山西大医院泌尿外科(太原, 030032)

详细信息

通讯作者: 张雁钢,E-mail:urozyg@163.com

中图分类号: R737.25

收稿日期: 2017-01-21

Bilateral intrafascial versus interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer: a meta-analysis of safety and efficacy

- Department of Urology, Shanxi Dayi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, China

More Information

Corresponding author: ZHANG Yangang, E-mail: urozyg@163.com

Received Date: 21 January 2017

摘要

摘要: 目的：系统评价筋膜内与筋膜间保留双侧神经的腹膜外腹腔镜前列腺癌根治术（extraperitoneal laparoscopic radical prostatectomy，ELRP）安全性及疗效。方法：计算机检索PubMed、Medline、Ovid、The Cochrane Library、CNKI、VIP及万方数据库，全面收集有关比较筋膜内与筋膜间保留神经的ELRP的临床对照试验，检索时限截止2016年11月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后，采用RevMan 5.3软件进行Meta分析。结果：纳入5篇研究，共1 111例患者。Mate分析结果显示：病理pT2c期[OR=1.39，95% CI （1.05，1.83），P=0.02]，筋膜间组优于筋膜内组。术后6个月[OR=2.38，95% CI （1.68，3.37），P<0.0001]和12个月[OR=2.36，95% CI （1.61，3.47），P<0.0001]勃起功能恢复率，对于≤65岁的患者术后6个月[OR=2.69，95% CI （1.61，4.48），P=0.0002]和12个月[OR=2.71，95% CI （1.51，4.87），P=0.0008]勃起功能恢复率，术后3个月[OR=0.21，95% CI （0.09，0.47），P=0.0002]和6个月[OR=0.17，95% CI （0.10，0.30），P<0.0001]重度尿失禁等方面筋膜内组优于筋膜间组。而pT2、pT3、pT2a、pT2b、pT3a、pT3c病理分期，总的、pT2、pT3期切缘阳性率，1年无生化进展生存率，术后6个月、12个月的勃起功能恢复率（>65岁的患者），术后3个月、6个月、12个月轻度尿失禁，术后12个月重度尿失禁等方面筋膜内组与筋膜间组差异无统计学意义（P>0.05）。结论：在严格掌握适应证的前提下，筋膜内组术后控尿恢复时间短，年轻患者勃起功能恢复率高，而病理学分期、切缘阳性率、短期肿瘤效果方面与筋膜间组差异无统计学意义。因此，在兼顾肿瘤学的原则下，临床上对于≤65岁勃起功能正常的低危局限性前列腺癌患者，优先推荐采用筋膜内保留神经前列腺癌腹腔镜根治术。
- 筋膜内保留神经 /
- 筋膜间保留神经 /
- 腹腔镜前列腺癌根治术 /
- 前列腺癌 /
- Meta分析
Abstract: Objective: To evaluate the safety and efficacy of bilateral intrafascial versus interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer.Method: The databases of PubMed, Medline, Ovid, The Cochrane Library, CNKI, VIP and Wang fang Data were searched to get controlled clinical trials about intrafascial versus interfascial nerve-sparing techniques in extraperitoneal LRP for prostate cancer.The retrieval time span was from inception to Nov.2016.The studies were screened according to the inclusion and exclusion criteria, and the data were extracted and the quality was evaluated by two reviewers independently.And then the meta-analysis was conducted using RevMan 5.3software.Result: A total of five studies were included, and 1111 cases were involved.The meta-analysis showed:pT2cstage[OR=1.39, 95%CI (1.05, 1.83), P=0.02], which showed interfascial group was better than intrafascial group.Erectile function recovery rate at six months[OR=2.38, 95%CI (1.68, 3.37), P<0.0001]and 12 months after surgery[OR=2.36, 95% CI (1.61, 3.47), P<0.0001], erectile function recovery rate for patients ≤ 65years of age at six months[OR=2.69, 95%CI (1.61, 4.48), P=0.0002]and 12 months after surgery[OR=2.71, 95%CI (1.51, 4.87), P=0.0008], severe urinary incontinence at three months[OR=0.21, 95%CI (0.09, 0.47), P=0.0002]and six months after surgery[OR=0.17, 95%CI (0.10, 0.30), P<0.0001], which showed intrafascial group was better than interfascial group.No statistically significant difference was found between the two groups in pT2, pT3, pT2 a, pT2b, pT3 a, pT3b, positive surgical margin rate in overall, pT2 and pT3, one-year biochemical progression-free survival rate, or in the improvement of the erectile function recovery rate (for patients>65years of age) at 6and 12 months, mild urinary incontinence at 3, 6and 12 months, or severe urinary incontinence at 12 months after surgery (P>0.05).Conclusion: Under strict indication, for patients ≤ 65years of age of intrafascial group experience a faster recovery of urinary continence and higher recovery rate of erectile function, but no significant difference was found between intrafascial group and interfascial group in pathological stage, positive margin rate, short-term oncological results.Therefore, under the principle of balancing oncology, for patients with normal erectile function ≤ 65years of age and low-risk localized prostate cancer, priority reservations recommended intrafascial nerve-sparing laparoscopic radical prostatectomy.
- intrafascial nerve-sparing /
- interfascial nerve-sparing /
- laparoscopic radical prostatectomy /
- prostate cancer /
- meta analysis

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