机器人辅助腹腔镜与标准腹腔镜前列腺癌根治术疗效比较的Meta分析

Comparison of Perioperative and Functional Outcomes between Standard Laparoscopic and Robotic-Assisted Radical Prostatectomy: A Systemic Review and Meta-Analysis

摘要: [目的] 评价机器人辅助腹腔镜前列腺癌根治术(RARP)与标准腹腔镜前列腺癌根治术(LRP)治疗局限性前列腺癌的临床疗效。[方法] 检索EMBASE、MEDLINE、PubMed、Cochrane图书馆，并选择有关LRP与RARP临床疗效的随机对照研究(RCTs)和非随机对照研究(包括前瞻和回顾性研究)，应用系统评价软件Rev Man5.3进行Meta分析。[结果] 通过文献检索共纳入24个研究，包括2个RCTs、7个前瞻性和15个回顾性研究。Meta分析表明：两组在手术时间、导尿管留置时间、住院时间和总体并发症发生率方面无统计学差异(P > 0.05)。但在失血量、输血率、术后3、6、12月的控尿和勃起功能恢复方面，RARP组明显优于LRP组(P < 0.05)。[结论] 与LRP相比，RARP在局限性前列腺癌的手术治疗中出血量少、输血率低，且在术后控尿和勃起功能恢复上较LRP更有优势。

Abstract: [Objective] The goal of this study was to perform a systemic review and meta-analysis to evaluate the perioperative and functional outcomes between laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP). [Methods] A literature search of EMBASE, MEDLINE, PubMed, and Cochrane Library databases was conducted. We selected randomized controlled trials (RCTs) and non-randomized comparative studies (including prospective and retrospective studies) comparing perioperative and functional outcomes of both LRP and RARP, and meta-analysis was applied using the Review Manager 5.3 software. [Results] Twenty-four studies were identified in the literature search, including 2 RCTs, 7 prospective studies, and 15 retrospective studies. LRP and RARP showed similarity in the operative time, catheterization duration, in-hospital stay, and overall complication rate (P > 0.05). However, blood loss and transfusion rate were lower in RARP (P < 0.05). Moreover, RARP was associated with significantly improved outcomes for continence and potency rates to those of LRP at 3, 6, and 12 months postoperatively (P < 0.05). [Conclusion] RARP was associated with lower blood loss and transfusion rate and much greater functional outcomes in contrast to LRP.