保留肾上腺手术与肾上腺全切除术治疗醛固酮腺瘤疗效比较的meta分析

摘要

目的 比较腹腔镜下保留肾上腺与肾上腺全切除术治疗醛固酮腺瘤的围术期安全性及术后疗效.方法 在线系统地检索PubMed、ScienceDirect、Springerlink、the Cochrane Library、中国知网、中国生物医学文献数据库于2016年5月之前发表的关于保留肾上腺(ASS)或肾上腺部分切除术(PA)对比肾上腺全切除术(TA)治疗醛固酮腺瘤(APA)的文献资料,将入选的研究文献应用Revman 5.3软件进行meta分析,分析的主要内容是围术期结果(手术时间、术中出血量、住院时间)以及术后疗效(治愈率、部分缓解率、无效率).结果 最终共纳入9篇临床研究文献,其中3篇英文文献,6篇中文文献,共包括1036例患者,其中ASS组544例,TA组492例.结果显示,ASS对比TA的手术时间(WMD:-2.09min,95％CI:-9.86～5.67,P=0.60)、术中出血量(WMD:1.13ml,95％CI:-8.86～11.12,P=0.82)、住院时间(WMD:-0.10d,95％CI:-0.32～0.12,P=0.36)差异无统计学意义,而ASS对比TA在治愈率(OR=l.07,95％CI:0.73～1.58,P=0.72)、部分缓解率(OR=0.85,95％CI:0.57～1.27,P=0.43)、无效率(OR=2.15,95％CI:0.32～14.34,P=0.43)差异亦无统计学意义.结论 在醛固酮腺瘤的手术治疗中,与肾上腺全切除术比较,保留肾上腺手术技术上安全可靠,术后疗效肯定,二者具有相似的治疗效果,值得进一步在临床上推广.%Objective To compare the perioperative safety and curative effects oflaparoscopic adrenal sparing surgery (ASS) with laparoscopic total adrenalectomy (TA) for aldosterone producing adenoma (APA).Methods An online systematical retrieval was performed with Pubmed,ScienceDirect,Springerlink,the Cochrane library,CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016,these studies reported the treatment of ASS/partial adrenalectomy (PA) versus TA for APA.The selected studies were applied to Revman 5.3 software for meta-analysis.The main contents were perioperative outcomes (operative time,intra-operative blood loss,and length of hospital stay) and postoperative efficacy (cure rate,partial response rate,inefficiency rate).Results A total of 9 clinical studies (3 English documents and 6 Chinese documents) with 1036 patients were included into the final analysis,among which 544 patients were assigned to ASS group and 492 in TA group.The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD:-2.09min,95％CI:-9.86-5.67,P=0.60),length of hospital stay (WMD:-0.10d,95％CI:-0.32-0.12,P=0.36),intra-operative blood loss (WMD:1.13ml,95％CI:-8.86-11.12,P=0.82),cure rate (OR=l.07,95％CI:0.73-1.58,P=0.72),partial response rate (OR=0.85,95％CI:0.57-1.27,P=0.43) and inefficiency rate (OR=2.15,95％CI:0.32-14.34,P=0.43).Conclusion For surgical treatment of APA,ASS is technically safe,can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA,so deserves further application in clinical practice.