Williamson Adam, Paterson Sureyya, Erolin Caroline, Sweeney Clare, Townell Nicholas, Nabi Ghulam
Academic Department of Urology, Ninewells Hospital and Medical School , Dundee, Scotland, United Kingdom .
J Endourol. 2014 Nov;28(11):1268-77. doi: 10.1089/end.2014.0311. Epub 2014 Aug 21.
Indications for laparoscopic renal surgery are increasing; however, benefits in adult polycystic kidney disease (APKD) remain uncertain. Our objective was to systematically synthesize the reported literature on safety, feasibility, complications, and early outcomes of laparoscopic nephrectomy in APKD to determine clinical benefits for surgical practice.
We conducted a meta-analysis of the published literature reporting on laparoscopic nephrectomy in APKD between 1991 and 2013. The criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study were used to assess the quality of reported literature.
One prospective and 15 retrospective studies of low to modest quality (according to the STROBE checklist) were identified, reporting on 293 patients who underwent laparoscopic nephrectomy for APKD. None of the studies was a randomized clinical trial (RCT). The transperitoneal approach was the most commonly used technique. Body mass index ranged from 16 to 57 (mean 26.2 kg/m(2); 53% of patients were dialysis dependent, and 31% had a previous or simultaneous transplant. Kidney length ranged from 8 to 50 cm (mean 34.5cm), and the mean mass of affected kidneys was 1647 g (range 132 g-7200 g). Duration of hospital stay ranged from 2.6 to 11 days (mean 4.9 days). Operative time ranged from 90 to 568 minutes, with 16.2% of patients needing blood transfusion. There were 24 intraoperative complications and 68 postoperative complications, a rate of 8% and 24%, respectively. A total of 16 (5%) cases were converted to an open technique. No mortality was reported in any of the included studies.
The quality of the included studies is poor, and it is difficult to argue for or against change in clinical practice because the evidence included is of level 3 and 4 only. Higher quality studies are needed to demonstrate that the technique is generalizable across all populations.
腹腔镜肾手术的适应证正在增加；然而，其在成人多囊肾病（APKD）中的益处仍不明确。我们的目的是系统地综合已报道的关于APKD患者腹腔镜肾切除术的安全性、可行性、并发症及早期结局的文献，以确定其对手术实践的临床益处。
我们对1991年至2013年间发表的关于APKD患者腹腔镜肾切除术的文献进行了荟萃分析。采用流行病学观察性研究报告强化（STROBE）研究的标准来评估所报道文献的质量。
共确定了1项前瞻性研究和15项质量低至中等（根据STROBE清单）的回顾性研究，报告了293例行APKD腹腔镜肾切除术的患者。所有研究均非随机临床试验（RCT）。经腹途径是最常用的技术。体重指数范围为16至57（平均26.2kg/m²）；53%的患者依赖透析，31%曾接受过或同时进行过移植手术。肾脏长度范围为8至50cm（平均34.5cm），患侧肾脏平均质量为1647g（范围132g至7200g）。住院时间范围为2.6至11天（平均4.9天）。手术时间范围为90至568分钟，16.2%的患者需要输血。术中并发症24例，术后并发症68例，发生率分别为8%和24%。共有16例（5%）病例转为开放手术。纳入的任何研究均未报告死亡病例。
纳入研究的质量较差，且难以支持或反对临床实践的改变，因为所纳入的证据仅为3级和4级。需要更高质量的研究来证明该技术在所有人群中都具有可推广性。
