腹腔镜肾部分切除术与腹腔镜冷冻消融术治疗小肾肿瘤的安全性和疗效的Meta分析

Laparoscopic partial nephrectomy versus 1aparoscopic cryoablation for the small renal tumors: a meta-analysis of safety and efficacy

摘要:

目的??系统评价腹腔镜肾部分切除术（LPN）与腹腔镜冷冻消融术（LCA）治疗小肾肿瘤（SRMs）的安全性及疗效。方法?计算机检索PubMed、SCI、Ovid、The Cochrane Library、CNKI、CBM、VIP及万方数据库，全面收集有关LPN与LCA比较治疗SRMs的临床对照试验，检索时限截至2016年4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9篇研究，共748例患者。Meta分析结果显示：LCA较LPN手术时间短[均数差（MD）=42.75，95%CI（12.19，73.31），P =0.006]，术中出血量少[MD=190.73，95%CI（126.67，254.78），P =0.000]，住院时间短[MD=2.23，95% CI（0.17，4.28），P =0.030]，术式转换率低[比值比（OR）=3.54，95%CI（1.18，10.59），P =0.020]，并发症少[OR=3.90，95%CI（1.84，8.24），P =0.000]，术后肾小球滤过率（GFR）下降量低[MD=10.30，95%CI（5.38，15.24），P =0.000]，局部复发风险高[OR=0.13，95%CI（0.04，0.44），P =0.000]，远处转移风险高[OR=0.16，95%CI（0.03，0.78），P =0.020]，而在术后血肌酐（Scr）上升量、输血率比较差异均无统计学意义（P >0.05）。结论?LCA在围手术期结果、保护肾功能方面更有优势，但其有较高的肿瘤局部复发和远处转移风险，近期、中期疗效相当，远期疗效尚不明确，故在手术病例的选择上仍需谨慎。

Abstract:

Objective?To evaluate the safety and efficacy of Laparoscopic partial nephrectomy (LPN) versus 1aparoscopic cryoablation (LCA) for the small renal tumors (SRMs).?Methods?The databases of PubMed, SCI, Ovid, the Cochrane Library, CNKI, CBM, VIP and Wangfang Data were searched to controlled clinical trial about LPN versus LCA for the treatment of small renal tumor. The retrieval time span was from inception to Apr 2016. The studies were screened according to the inclusion and exclusion criteria, the date were extracted and the quality was evaluated by 2 reviewers independently. And then the Meta-analysis was conducted using RevMan 5.3 software.?Results?9 studies were included, and 748 cases were involved. The meta-analysis showed that comparing with LPN, the operation time of LCA was shorter [MD = 42.75, 95 % CI (12.19 ~ 73.31), P = 0.006], less intraoperative blood loss [MD = 190.73, 95 % CI (126.67 ~ 254.78), P = 0.000], shortening hospital stay [MD = 2.23, 95 % CI (0.17 ~ 4.28), P = 0.030], lower transfusion rate [OR = 3.54, 95 % CI (1.18 ~ 10.59), P = 0.020], lower rate of postoperative glomerular filtration levels [MD = 10.30, 95 % CI (5.38 ~ 15.24), P = 0.000], less complications [OR = 3.90, 95 % CI (1.84 ~ 8.24), P = 0.000], higher risk of local recurrence [OR = 0.13, 95 % CI (0.04 ~ 0.44), P = 0.000], higher risk of distant metastases [OR = 0.16, 95 % CI (0.03 ~ 0.78), P = 0.020], but there were no significant differences in postoperative creatinine rise and transfusion rate (P > 0.05).?Conclusions?LCA has advantage in perioperative period results and protect renal function. But LCA has a higher local recurrence and distant metastasis risk, short-term and medium-term efficacy considerably, long-term effect is not clear, therefore, in the choice of surgical cases still need to be careful.