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目的系统评价腹腔镜保留盆腔自主神经直肠癌根治术(L-PANP)与传统开腹手术(O-PANP)治疗对直肠癌男性患者的排尿及性功能的影响。方法计算机检索Pub Med、Embase、The Cochrane library、Web of Science、CBM、CNKI、VIP和Wan Fang等数据库,搜集从建库至2015年2月L-PANP与O-PANP的随机与非随机临床对照试验,按Cochrane系统评价的方法筛选文献,按纳入标准提取数据并进行质量评价;采用Rev Man 5.1软件进行Meta分析。结果最终纳入9项研究,共934例患者。Meta分析结果显示,相比O-PANP组,L-PANP组能降低患者术后近期排尿功能障碍发生率(OR=0.32,95%CI:0.21~0.48,P<0.01),有效减少患者术后近期勃起功能障碍(OR=0.33,95%CI:0.23~0.49,P<0.01)及射精功能障碍(OR=0.31,95%CI:0.25~0.53,P<0.01)。两组患者在术后1年盆腔局部复发率方面无明显差异(OR=1.10,95%CI:0.27~4.57,P>0.05)。结论 L-PANP能有效保护患者术后的排尿及性功能,改善患者生活质量。但由于纳入文献的类型及评价质量不高等因素的限制,尚需谨慎对待此结论。
Objective To evaluate the effects of laparoscopic conservative pelvic autonomic nerve rectal cancer (L-PANP) and conventional open surgery (O-PANP) on urination and sexual function in male patients with rectal cancer. Methods The databases of Pub Med, Embase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wan Fang were searched by computer. Randomized and non-randomized controlled clinical trials of L-PANP and O-PANP According to the Cochrane systematic review, we screened the literature, extracted the data according to the inclusion criteria, and evaluated the quality. Meta-analysis was performed using Rev Man 5.1 software. The results eventually included 9 studies, a total of 934 patients. Meta-analysis showed that compared with O-PANP group, L-PANP group could reduce the incidence of postoperative urination dysfunction (OR = 0.32, 95% CI: 0.21-0.48, P <0.01) Recent erectile dysfunction (OR = 0.33, 95% CI: 0.23-0.49, P <0.01) and ejaculation dysfunction (OR = 0.31, 95% CI: 0.25-0.53, P <0.01). There was no significant difference in the local recurrence rate between the two groups at 1 year (OR = 1.10, 95% CI: 0.27-4.57, P> 0.05). Conclusion L-PANP can effectively protect the patient’s urination and sexual function and improve the quality of life of patients. However, due to the type of literature included and the quality of the evaluation is not high and other factors, this conclusion needs to be treated with caution.