Chen Wei, Li Fei, Chen Dingnan, Zhu Yongtong, He Chengwu, Du Yuejun, Tan Wanlong
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Surg Laparosc Endosc Percutan Tech. 2013 Apr;23(2):121-7. doi: 10.1097/SLE.0b013e3182827b57.
The study aims to provide a pooled meta-analysis of existing studies that compare the outcomes of retroperitoneal laparoscopic adrenalectomy with transperitoneal approach for adrenal tumor.
A systematic search of electronic databases was performed and studies were selected based on specific inclusion and exclusion criteria. Data of interest were subjected to meta-analysis using randomized or fixed-effect model to calculate weight mean difference (WMD) or odds ratio (OR). The sensitivity analysis and publication bias test also be conducted.
Nine observational studies with 632 patients were identified (339 retroperitoneal vs. 293 transperitoneal). Retroperitoneal approach was associated with shorter operative time [WMD=-13.10; 95% confidence interval (CI), -23.83 to -2.36; P=0.02], less intraoperative blood loss (WMD=-40.60; 95% CI, -79.73 to -1.47; P=0.04), shorter duration of hospital stay (WMD=-1.25; 95% CI, -2.36 to -0.14; P=0.03), or time to first ambulation (WMD=-0.38; 95% CI, -0.47 to -0.28; P<0.001). Although the difference between number of convert to open management, time to first oral intake, and major postoperative complication rate was not significant (OR=0.53; 95% CI, 0.17 to 1.60; P=0.26; WMD=-0.31; 95% CI, -1.14 to 0.52; P=0.47; OR=0.41; 95% CI, 0.06 to 1.06; P=0.07).
The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal tumor in short-term outcomes. However, extended follow-ups and further randomized controlled trials should be required to analysis.
本研究旨在对比较后腹腔镜肾上腺切除术与经腹途径肾上腺肿瘤切除术疗效的现有研究进行汇总荟萃分析。
对电子数据库进行系统检索，并根据特定的纳入和排除标准选择研究。对感兴趣的数据采用随机或固定效应模型进行荟萃分析，以计算加权平均差（WMD）或比值比（OR）。还进行了敏感性分析和发表偏倚检验。
共纳入9项观察性研究，632例患者（后腹腔镜组339例，经腹组293例）。后腹腔镜手术方式与手术时间较短相关[WMD=-13.10；95%置信区间（CI），-23.83至-2.36；P=0.02]，术中出血量较少（WMD=-40.60；95%CI，-79.73至-1.47；P=0.04），住院时间较短（WMD=-1.25；95%CI，-2.36至-0.14；P=0.03），或首次下床活动时间较短（WMD=-0.38；95%CI，-0.47至-0.28；P<0.001）。虽然转为开放手术的例数、首次经口进食时间和术后主要并发症发生率之间的差异无统计学意义（OR=0.53；95%CI，0.17至1.60；P=0.26；WMD=-0.31；95%CI，-1.14至0.52；P=0.47；OR=0.41；95%CI，0.06至1.
