手助腹腔镜与开放手术活体供肾取肾术的系统评估

目的 系统评价手助腹腔镜下活体供肾切取术(HLDN)与开放活体供肾切取术(ODN)的安全性及效果。方法 采用计算机互联网检索Pubmed数据库、Sciverse数据库、考克兰图书馆数据库、中国知网、中文科技期刊数据库、中国生物医学文献数据库及万方数据库收录期刊已发表的包含HLDN和ODN两种术式的随机对照试验(RCT)研究。两位研究者根据纳入、排除标准独立筛选文献,应用RevMan 5.2软件进行Meta分析。结果 通过筛选共纳入10个RCT,共1 230例患者。Meta分析结果提示,活体供肾取肾时,与ODN术式比较,HLDN术式的手术时间和热缺血时间较长[合并比值比(OR)值为35.81,95%可信区间(CI)13.98~57.65,P=0.001;合并OR 43.99,95% CI 32.31~55.66,P<0.00001],但HLDN术式的术中出血量较少(合并OR-78.90,95% CI -123.59~-34.22,P=0.0005)、并发症发生率较低(合并OR0.58,95%CI0.39~0.86,P=0.006)、住院时间较短[权重均差(WMD)为-1.15,95%CI-1.40~-0.90,P<0.00001];两组患者的术后进普食时间差异无统计学意义(WMD为-0.11,95%CI -0.67~-0.45,P=0.70)。结论 与ODN术式比较,HLDN术式提高了手术的安全性,降低了手术难度,值得临床推广应用。

System evaluation of hand-assisted laparoscopic and open living donor nephrectomy

Objective To evaluate the safety and effectiveness of hand-assisted laparoscopic donor nephrectomy （HLDN） and open donor nephrectomy （ODN） systematically. Methods Literatures of randomized controlled trials （RCT） about HLDN and ODN were searched in Pubmed, Sciverse, Cochrone Library, China National Knowledge Infrastructure （CNKI）, China Scientific Journal Database （VIP）, China Biology Medicine （CBM） , and Wangfang Database through internet. According to the inclusion and exclusion criteria, 2 reviewers screened the literatures independently, and Meta-analysis was conducted by software RevMan 5.2. Results A total of 10 RCTs including 1 230 patients were eligible after screening. Compared with ODN, the Meta-analysis revealed that HLDN possessed significantly longer operation duration and warm ischemia time [pooled odds ratio （OR） =35.81, 95% confidence interval （CI）： 13.98-57.65, P = 0. 001 ; pooled OR = 43.99, 95% CI： 32.31-55.66, P 〈 0. 00001 ）, but less intraoperative blood loss （pooled OR = - 78.90, 95% CI： - 123.59 - - 34. 22, P = 0. 0005 ） , lower incidence of complications （ pooled OR = 0. 58, 95 % CI： O. 39 - 0. 86, P = 0. 006）, and shorter hospital length of stay [ weight mean difference （WMD） = - 1.15, 95% CI： - 1.40- - 0. 90, P 〈 0. 000011. There was no significant difference in the time of takingnormal diet between two groups （WMD = -0. 11, 95% CI： -0.67 --0.45, P =0.70）. Conclusions Compared with ODN, HLDN can improve the safety of operation and reduce the difficulty of operation. It is worthy of clinical promotion and application.