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目的:用Meta分析评价选择性阻断肾动脉肾部分切除术与全部阻断肾动脉肾部分切除术的安全性和疗效,对临床上治疗肾肿瘤提供循证证据。方法:通过计算机检索PubMed、Web of Science、Cochrane library、CNKI、CBM和万方数据库,查找比较选择性阻断肾动脉肾部分切除术与全部阻断肾动脉肾部分切除术疗效的临床对照研究相关文献,手检纳入文献的参考文献,检索时限均从建库至2014年12月31日。按照纳入和排除标准,两位评价者独立进行文献筛查、质量评价和数据提取,采用RevMan 5.2软件进行Meta分析。结果:共10篇临床对照研究,共涉及肾部分切除术患者787例,其中采用选择性阻断肾动脉肾部分切除术285例(选择性阻断组),采用全部阻断肾动脉肾部分切除术502例(全部阻断组)。Meta分析结果显示:选择性阻断组与全部阻断组在术中失血量方面差异有统计学意义(SWD=39.07,95%CI 4.66~73.49,P=0.03),选择性阻断组术中失血量多于全部阻断组;在手术时间、住院时间、切缘阳性率、输血、并发症等方面差异无统计学意义,而在围手术期肾功能(SWD=12.44,95%CI 6.61~18.27,P<0.01),围手术期术后肾功能变化百分比(SWD=14.78,95%CI 10.46~19.11,P<0.01),术后3个月肾功能(SWD=13.42,95%CI 6.40~20.43,P=0.0002),术后3个月肾功能变化百分比(SWD=8.32,95%CI 3.92~12.71,P=0.0002)差异有统计学意义,选择性阻断组肾功能保护方面优于全部阻断组。结论:本Meta分析显示在合适患者选择下,选择性阻断肾动脉肾部分切除术具有与传统肾部分切除术一样的手术安全性,在术后短期肾功能保护方面,选择性阻断肾动脉术具有明显优势。因本Meta分析纳入的病例数较少,纳入研究固有局限性,有必要开展和设计大样本随机对照研究来进一步验证此结果。
OBJECTIVE: To evaluate the safety and efficacy of selective partial nephrectomy and partial nephrectomy in patients with renal artery by Meta-analysis, and provide evidence-based evidence for clinical treatment of renal neoplasm. Methods: A computer-based online search of PubMed, Web of Science, Cochrane Library, CNKI, CBM, and Wanfang databases was performed to compare the efficacy of selective partial nephrectomy for renal artery with partial nephrectomy for renal artery occlusion Literature, hand-checked into the literature references, search time from the database to December 31, 2014. According to inclusion and exclusion criteria, the two reviewers conducted independent screening, quality evaluation and data extraction, and Meta-analysis was performed using RevMan 5.2 software. Results: A total of 10 clinical controlled trials involving 787 patients undergoing partial nephrectomy were performed. Selective blocking of 285 cases of renal artery partial resection (selective blocking group) and partial nephrectomy of renal artery Surgery 502 cases (all blocking group). The results of Meta analysis showed that there was significant difference in intraoperative blood loss between the selective block group and the complete block group (SWD = 39.07, 95% CI 4.66-73.49, P = 0.03) There was no significant difference in blood loss, blood loss and total blood loss between the two groups. There was no significant difference in operative time, hospitalization time, positive margins, blood transfusion and complications. However, in the perioperative period, the renal function (SWD = 12.44,95% CI 6.61 ~ (SWD = 14.78, 95% CI 10.46 ~ 19.11, P <0.01). After 3 months of operation, the renal function (SWD = 13.42, 95% CI 6.40 ~ 20.43, P = 0.0002). The percentage of renal function changes at 3 months after operation (SWD = 8.32, 95% CI 3.92-12.71, P = 0.0002) was significantly different from that in selective block group Block the group. CONCLUSIONS: This Meta-analysis shows that under appropriate patient selection, selective partial nephrectomy of the renal artery has the same surgical safety as conventional partial nephrectomy and selectively blocks renal artery short-term renal function after surgery Surgery has obvious advantages. Because of the small number of cases enrolled in this Meta-analysis, incorporating the research’s inherent limitations, it is necessary to conduct and design large sample randomized controlled studies to further validate this result.