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目的系统评价腹腔镜手术与开腹手术比较切除常染色体显性多囊肾病(ADPKD)肾脏的有效性和安全性。方法计算机检索MEDLINE、EMbase、The Cochrane Library(2015年1期)、Web of Science、CBM和WanFang Data数据库,搜集腹腔镜手术与开腹手术比较切除ADPKD肾脏的相关临床研究,检索时限均从建库至2015年1月。由2位评价员独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入6个回顾性队列研究,包括182例患者。Meta分析结果显示:与开放性肾切除术比较,腹腔镜组患者的平均住院日[MD=–4.38 d,95%CI(–5.93,–2.83),P=0.000 01]和输血风险明显更低[OR=0.25,95%CI(0.10,0.62),P=0.003],但两组在总并发症发生率方面差异无统计学意义[OR=0.51,95%CI(0.24,1.06),P=0.07]。结论腹腔镜肾切除术相比开放手术治疗ADPKD可以减少住院时间,降低输血风险,但两种手术方式的总并发症发生率相当。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the effectiveness and safety of laparoscopic versus open surgery in the removal of the kidneys of autosomal dominant polycystic kidney disease (ADPKD). Methods The clinical data of MEDLINE, EMbase, The Cochrane Library (2015, 1), Web of Science, CBM and WanFang Data were searched by computer and compared with laparoscopic surgery and laparotomy. Until January 2015. Two independent reviewers screened the literature, extracted the data, and evaluated the risk of being included in the study after the Meta-analysis using RevMan 5.4 software. Results A total of 6 retrospective cohort studies were included, including 182 patients. Meta-analysis showed that the mean length of stay (MD = -4.38 days, 95% CI (-5.93, -2.83), P = 0.000 01] and the risk of transfusion were significantly lower in the laparoscopic group compared with open nephrectomy (OR = 0.25,95% CI 0.10, 0.62, P = 0.003). However, there was no significant difference in the overall complication rates between the two groups (OR = 0.51, 95% CI 0.24, 1.06) 0.07]. Conclusions Laparoscopic nephrectomy compared with open surgery for ADPKD can reduce hospitalization time and reduce the risk of blood transfusion, but the overall complication rates for both procedures are comparable. Due to the limited number and quality of studies involved, the above conclusion still needs to be verified by more high-quality studies.