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背景目前关于机器人辅助肾部分切除术(RPN)和腹腔镜肾部分切除术(LPN)的效果和安全性均存在一定争论。目的对比分析RPN和LPN的临床效果。方法以“Robotics AND Nephrectomy”“Robotics AND Nephrectomy AND Laparoscopy”“Robotics AND Laparoscopy AND Nephrectomy AND Partial”“LPN AND RPN”为英文检索词,以“机器人辅助肾部分切除术AND腹腔镜肾部分切除术”为中文检索词,在PubMed、CNKI及维普数据库中检索从建库至2013-05-31发表的随机对照试验,利用Review Manager 5.2.5(Java 6)软件进行数据处理,对RPN组和LPN组的估计出血量、手术时间、热缺血时间、并发症、切缘阳性及住院时间进行分析。结果共筛选出10篇符合要求的文献,均为外文文献。RPN组和LPN组的估计出血量间差异有统计学意义〔标准差(MD)=40.70,95%CI(24.46,56.93),Z=4.91,P<0.01〕,但手术时间〔MD=4.21,95%CI(-21.76,30.19),Z=0.32,P=0.75〕、热缺血时间〔MD=-2.91,95%CI(-8.19,2.37),Z=1.38,P=0.28〕、并发症发生率〔OR=1.25,95%CI(0.66,2.36),Z=0.68,P=0.50〕、切缘阳性率〔OR=0.99,95%CI(0.46,2.14),Z=0.02,P=0.98〕及住院时间〔OR=-0.04,95%CI(-0.22,0.14),Z=0.44,P=0.66〕间差异均无统计学意义。亚组分析显示,RPN组和LPN组估计出血量〔MD=-6.89,95%CI(-99.82,86.04),P=0.88〕和手术时间〔MD=11.32,95%CI(-25.90,48.55),P=0.55〕间差异无统计学意义,但RPN组热缺血时间少于LPN组〔MD=-2.83,95%CI(-4.53,-1.13),P=0.001〕。结论 RPN和LPN具有同样的手术效果,且RPN热缺血时间较LPN短,这对保护肾功能有积极作用。
Background There is currently some debate about the efficacy and safety of robotic-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN). Objective To compare the clinical effects of RPN and LPN. Methods Using “Robotics AND Nephrectomy ” “Robotics AND Nephrectomy AND Laparoscopy ” “Robotics AND Laparoscopy AND Nephrectomy AND Partial ” “LPN AND RPN ” as the English term and “robot assisted partial nephrectomy AND Laparoscopic partial nephrectomy ”as a Chinese term to search PubMed, CNKI and VIP database for randomized controlled trials published from the database to 2013-05-31, using Review Manager 5.2.5 (Java 6) software Data processing, the estimated bleeding volume, operation time, warm ischemia time, complications, positive margins and length of stay in RPN group and LPN group were analyzed. Results A total of 10 articles were found, all of which were foreign literature. The estimated bleeding between RPN group and LPN group was statistically significant (standard deviation = 40.70,95% CI 24.46,56.93, Z = 4.91, P <0.01), but the operative time (MD = 4.21, 95% CI (-21.76, 30.19), Z = 0.32, P = 0.75), warm ischemic time [MD = -2.91,95% CI (-8.19,2.37), Z = 1.38, P = (OR = 1.25,95% CI 0.66,2.36, Z = 0.68, P = 0.50). The positive rate of margins [OR = 0.99,95% CI 0.46,2.14], Z = 0.02, P = 0.98 ] And hospital stay 〔OR = -0.04, 95% CI (-0.22,0.14), Z = 0.44, P = 0.66〕 between the two groups had no statistical significance. Subgroup analyzes showed that bleeding was estimated in the RPN and LPN groups (MD = -6.89, 95% CI (-99.82, 86.04), P = 0.88) and operation time [MD = 11.32, 95% CI (-25.90, 48.55) , P = 0.55], but the time of warm ischemia in RPN group was less than that in LPN group [MD = -2.83, 95% CI (-4.53, -1.13), P = 0.001]. Conclusion RPN and LPN have the same surgical effect, and the warm ischemia time of RPN is shorter than LPN, which has a positive effect on the protection of renal function.