国际麻醉学与复苏杂志   2020, Issue (6): 11-11
    
区域麻醉对比全身麻醉对前列腺癌患者术后转归影响的Meta分析
郝泉水, 张慧, 胡亮, 黎军, 吴耀华1()
1.黄冈市中心医院
Comparison between the effects of regional anesthesia and general anesthesia on the postoperative outcome of patients with prostate cancer: a Meta analysis
 全文:
摘要：

目的 应用Meta分析的方法评价区域麻醉对比全身麻醉对前列腺癌术后复发转移的影响。 方法 计算机检索PubMed、Cochrane Library、Ovidsp和ISI Web of knowledge数据库中区域麻醉对比全身麻醉用于前列腺癌根治术的随机对照试验（randomized controlled trial, RCT）或观察性研究，检索时间均从建库至2019年2月，两位研究者按照纳入标准筛选文献、提取资料，按照Cochrane协作网偏倚风险评估标准或纽卡斯尔‑渥太华量表（the Newcastle‑Ottawa Scale, NOS）对纳入研究的方法学质量进行评价，并采用Stata 11.0 进行Meta分析。 结果 共纳入11个研究（2个RCT，9个观察性研究），合计13 943例患者。区域麻醉对比全身麻醉，2个RCT及6个观察性研究报告了生化复发，二者在生化复发上的差异无统计学意义［RCT：风险比（hazard ratio, HR）=1.55，95%CI（0.86，2.78），P=0.146。观察性研究：HR=0.96，95%CI（0.79，1.16），P=0.675］；4个观察性研究报告了无复发生存，二者在无复发生存时间上差异无统计学意义［HR=1.02，95%CI（0.89，1.16），P=0.829］；3个观察性研究报告了肿瘤进展，二者在肿瘤进展上差异无统计学意义［HR=0.56，95%CI（0.30，1.04），P=0.065］；3个观察性研究报告了前列腺癌病死率，二者在前列腺癌病死率上差异无统计学意义［HR=0.70，95%CI（0.29，1.68），P=0.418］；3个观察性研究报告了全因死亡率，区域麻醉的全因死亡率低于全身麻醉［HR=0.77，95%CI（0.64，0.93），P=0.008］。 结论 区域麻醉对比全身麻醉在前列腺癌患者术后肿瘤复发转移上没有差异，但区域麻醉会降低前列腺癌根治术后患者全因死亡率。
关键词： 区域麻醉； 全身麻醉； 前列腺癌； 转移复发； Meta分析
Abstract:

Objective To compare the effects of regional anesthesia and general anesthesia on the relapse of prostate cancer patients after surgery through Meta analysis. Methods PubMed, Cochrane Library, Ovidsp and ISI Web of knowledge were retrieved for randomized controlled trial (RCT) or observational‑retrospective cohort studies concerning prostate cancer surgery under regional anesthesia or general anesthesia. The retrieval time was from the inception of the databases to February 2019. Two researchers screened and collected materials according to the criteria of inclusion. Then, the methodological quality was assessed using the Cochrane risk of bias tool for RCT, and the Newcastle‑Ottawa Scale. Stata 11.0 was used to conduct Meta‑analysis. Results A total of 11 studies (2 RCT studies and 9 observational‑retrospective cohort studies) involving 13 943 prostate cancer patients were included. There were biochemical relapses in 2 RCT studies and 6 observational‑retrospective cohort studies, without statistical difference ［RCT: hazard ratio (HR)=1.55, 95%CI (0.86,2.78), P=0.146. Observational studies: HR=0.96, 95%CI (0.79,1.16), P=0.675］. Four observational‑retrospective cohort studies reported no relapse survival. There was no statistical difference in non‑relapse survival time ［HR=1.02, 95%CI (0.89,1.16), P=0.829］. Three observational‑retrospective cohort studies reported tumor progression, without statistical difference between the two groups ［HR=0.56, 95%CI (0.30,1.04), P=0.065］. Three observational‑retrospective cohort studies calculated the morality of prostate cancer ［HR=0.70, 95%CI (0.29,1.68), P=0.418］. Three observational‑retrospective cohort studies reported the all‑cause morality and the results showed that regional anesthesia resulted in a lower all‑cause mortality than general anesthesia ［HR=0.77, 95%CI (0.64,0.93), P=0.008］. Conclusions There was no difference between regional anesthesia and general anesthesia in tumor recurrence and metastasis in patients with prostate cancer after surgery between general anesthesia and regional anesthesia. However, regional anesthesia may reduce the overall mortality in prostate cancer patients after surgery.
Key words: Regional anesthesia; General anesthesia; Prostate cancer; Metastasis and relapse; Meta analysis