机器人辅助腹腔镜前列腺切除术后耻骨上引流与尿道引流对比的meta分析

doi:10.19558/j.cnki.10-1020/r.2019.06.007

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摘要 目的：比较机器人辅助腹腔镜前列腺切除术（RARP）术后使用耻骨上膀胱引流（SPC）还是使用经尿道引流（UC）两种方式,旨在为临床选择提供更新的证据。方法：由两名研究人员独立检索截止至2018年12月的PubMed、Embase、Medline、Scopus、Ebscohost、中国期刊全文数据库（CNKI）和万方数据库（WanFang Data）,以确定对RARP术后使用SPC和UC进行比较的研究。对所纳入研究进行meta分析,所有分析均使用Review manager 5 (Cochrane Collaboration,China)进行。结果：共纳入10个研究,3组证据等级为1b的随机对照研究,4组回顾性研究和3组前瞻性非随机对照研究,总计1 209例患者（SPC组：623例,UC组：586例）。虽然SPC组与UC组在术后整体疼痛[POD1（MD=0.18,P=0.78）,POD3（MD=0.29,P=0.46）,POD6(7)(MD=-0.31,P=0.08)]方面差异无统计学意义。但在POD6（7）天的阴茎疼痛方面,SPC组疼痛评分低于UC组（MD=-1.05,P<0.001）。SPC组术后总体并发症发生率高于UC组（RR=2.15,P=0.02）,术后6周、12周尿失禁方面两组差异无统计学意义。组间尿潴留（RR=1.16,P=0.67）及膀胱痉挛（RR=0.68,P=0.36）的发生率均差异无统计学意义。而在术后尿路感染发生率方面,UC组高于SPC组,差异有统计学意义（RR=0.44,P=0.04）。结论：与UC组相比,SPC组能够减轻置管不适,且不会增加主要并发症的发生率。因此RARP术后使用SPC应该是一种安全有效的选择。

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	张桐桐
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	曲思凤
	智绪亭

关键词 ：机器人辅助腹腔镜前列腺切除, 耻骨上引流, 尿道引流, 系统综述, meta分析

Abstract：Objective： Prostate cancer is one of the cancer types in elder men. With the development of surgical robot technology, the robot-assisted laparoscopic radical prostatectomy (RARP) has gradually become the standard treatment, However, the postoperative use of suprapubic catheter (SPC) or urinary catheter (UC) is still controversial. The purpose of this paper is to provide updated evidence for comparison. Methods： Two individual researchers searched various datebases, including PubMed, Embase, Medline, Scopus, Ebscohost, CNKI and WanFang Data, with the time zone from each established time to December 2018. Then they compared the use of SPC and UC after RARP. The study took meta-analyses, all of which were performed by using the Review manager 5 (Cochrane Collaboration, China). Results： A total of 10 studies were included, including 3 groups of randomized controlled studies with evidence level 1b, 4 retrospective studies and 3 prospective non-randomized controlled studies, with a total of 1209 patients (623 in SPC group and 511 in UC group). There was no significant difference between the SPC group and the UC group in postoperative overall pain [POD1 (MD=0.18, P=0.78), POD3 (MD=0.29,P=0.46),POD6 (7)(MD=-0.31, P=0.08)]. However, SPC score of penile pain on POD6 (7) days, SPC score was lower than UC score (MD=-1.05, P<0.001).The overall postoperative complications were higher in the SPC group than in the UC group (RR=2.15, P=0.02), and there was no significant difference in urinary incontinence between the two groups at 6th and 12th weeks after surgery. There was no significant difference in the incidence of urinary retention (RR=1.16, P=0.67) or bladder spasm (RR=0.68, P=0.36) between the two groups, either. The incidence of postoperative urinary tract infection was higher in the UC group than in the SPC group, and the difference was statistically significant (RR=0.44, P=0.04). Conclusion： Compared with UC group, SPC group can reduce the discomfort of catheterization without increasing the probabilities of major complications. Therefore, SPC is a safe and effective choice for RARP surgery.

Key words： robot-assisted laparoscopic radical prostatectomy suprapubic catheter urinary catheter meta-analysis

收稿日期: 2019-05-17

ZTFLH:

R737.25

通讯作者: 智绪亭,zhixuting@hotmail.com

引用本文:

徐博文, 张桐桐, 薛春源, 申业壮, 张凯玥, 曲思凤, 智绪亭. 机器人辅助腹腔镜前列腺切除术后耻骨上引流与尿道引流对比的meta分析[J]. 微创泌尿外科杂志, 2019, 8(6): 390-398.
XU Bowen, ZHANG Tongtong, XUE Chunyuan, SHEN Yezhuang, ZHANG Kaiyue, QU Sifeng, ZHI Xuting. Suprapubic catheter versus urinary catheter after robot-assisted laparoscopic radical prostatectomy: a systematic review and meta-analysis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(6): 390-398.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1549.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I6/390

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