背景:本系统综述和荟萃分析比较了微创肾上腺切除术(MIA)与开放性肾上腺切除术(OA)在大肾上腺肿瘤(≥5cm)患者中的安全性和有效性。
方法:我们根据PRISMA(系统评价和荟萃分析的首选报告项目)和AMSTAR(系统评价方法学质量评估)指南对主要结局进行了系统评价和累积荟萃分析。包括Medline在内的五个数据库,PubMed,科克伦图书馆,Scopus,和WebofScience进行了系统搜索。搜索的时间范围从数据库的创建到2022年3月。
结果:共纳入10项研究,包括898名患者。与OA相比,MIA优于住院时间[LOSWMD=-3.52,95%CI(-4.61,-2.43),P<0.01],排水时间[DTWMD=-0.68,95%CI(-1.27,-0.09),P<0.05和空腹时间[FTWMD=-0.95,95%CI(-1.35,-0.55),P<0.01],估计失血量[EBLWMD=-314.22,95%CI(-494.76,-133.69),P<0.01和输血[WMD=-416.73,95%CI(-703.75,-129.72),P<0.01],而手术时间(OT)和并发症无统计学差异。对于嗜铬细胞瘤,MIA仍然优于LOS[WMD=-3.10,95%CI(-4.61,-1.60),P<0.01]和EBL[WMD=-273.65,95%CI(-457.44,-89.86),P<0.01],而OT和并发症没有显著差异。
结论:MIA在治疗大型肾上腺肿瘤方面优于OA,包括在特定的大肾上腺肿瘤-大嗜铬细胞瘤的情况下。
BACKGROUND: This systematic review and meta-analysis compared the safety and effectiveness of minimally invasive adrenalectomy (MIA) with open adrenalectomy (OA) in patients with large adrenal tumors (≥5 cm).
METHODS: We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Five databases including Medline, PubMed, Cochrane Library, Scopus, and Web of Science were systematically searched. The time frame of the search was set from the creation of the database to March 2022.
RESULTS: Ten studies including 898 patients were included. Compared to OA, MIA is superior for length of stay [LOS WMD = -3.52, 95% CI (-4.61, -2.43), P < 0.01], drainage time [DT WMD = -0.68, 95% CI (-1.27, -0.09), P < 0.05] and fasting time [FT WMD = -0.95, 95% CI (-1.35, -0.55), P < 0.01], estimated blood loss [EBL WMD = -314.22, 95% CI (-494.76, -133.69), P < 0.01] and transfusion [WMD = -416.73, 95% CI (-703.75, -129.72), P < 0.01], while operative time (OT) and complications are not statistically different. For pheochromocytoma, MIA remains superior for LOS [WMD = -3.10, 95% CI (-4.61, -1.60), P < 0.01] and EBL [WMD = -273.65, 95% CI (-457.44, -89.86), P < 0.01], while OT and complications are not significantly different.
CONCLUSIONS: MIA offers advantages over OA in the management of large adrenal tumors, including in the case of a specific large adrenal tumor - large pheochromocytoma.