机器人手术与腹腔镜手术在直肠癌低位前切除术中疗效的Meta分析  

Robotic versus laparoscopic low anterior resection: a meta-analysis

作　　者：徐慧荣[1,2] 李健宁 李增军[1] 徐忠法[1] 

机构地区：[1]山东省肿瘤医院胃肠外科,山东济南250117 [2]济南大学医学与生命科学学院 山东省医学科学院,山东济南250200 [3]山东省医科院附属医院麻醉科,山东济南250031

出　　处：《山东大学学报（医学版）》2014年第7期60-65,共6页Journal of Shandong University:Health Sciences

基　　金：山东省科技攻关计划(2010g0021859);山东省自然科学基金(ZR2010HL024)

摘　　要：目的对机器人直肠癌低位前切除术(R-LAR)与传统腹腔镜直肠癌低位前切除术(L-LAR)的短期疗效进行Meta分析。方法系统检索Medline、Embase、Ovid、中国知网全文数据库(CNKI)、万方数据库,比较R-LAR与L-LAR的所有病例-对照研究,包括发表和未发表的资料和会议论文。由两名作者独立进行方法学质量评价后,采用RevMan 5.2软件进行Meta分析。结果共纳入6篇有关的病例-对照研究,合计375例患者。Meta分析结果表明,机器人低位直肠癌前切除术(R-LAR)组与传统腹腔镜低位直肠癌前切除术(L-LAR)组相比,住院时间缩短(MD=-1.09,95%CI:-1.95^-0.22,P=0.01),中转开腹率(OR=0.09,95%CI:0.02~0.47,P=0.005)、总并发症(OR=0.55,95%CI:0.32~0.95,P=0.03)及环周切缘阳性率(OR=0.3,95%CI:0.11~0.83,P=0.02)均较低,有统计学差异,在手术时间(MD=34.25,95%CI:-5.09~73.58,P=0.09)及淋巴结清扫数目(MD=1,95%CI:-0.67~2.67,P=0.24)方面无统计学差异。结论在术后短期疗效方面,机器人直肠癌低位前切除术优于传统腹腔镜直肠癌低位前切除术。Objective To compare the short-term efficacy of robotic low anterior resection（ R-LAR） versus laparoscopic low anterior resection（ L-LAR） for rectal cancer with meta-analysis. Methods Databases including Medline,Embase,Ovid,CNKI and WANFANG were searched for studies that compared clinical or oncologic outcomes of R-LAP and L-LAP. Relevant published and unpublished data and references were also retrieved. The methodological quality of the incorporated researches was evaluated by two reviewers independently,and RevMan 5. 2 software was used for meta-analysis. Results Six studies with 375 patients were included in the analysis. The results showed that R-LAP had longer hospital stay[MD =-1. 09,95% CI（-1. 95 to-0. 22）,P = 0. 01],lower conversion rate[OR =0. 09,95% CI（ 0. 02 to 0. 47）,P = 0. 005],lower circumferential margin involvement positive rate[OR = 0. 3,95% CI（ 0.11 to 0.83）,P =0.02],lower overall complication rate[OR =0.55,95%CI（ 0.32 to 0.95）,P =0.03]compared with L-LAP. There was no difference in operation time[MD = 34. 25,95% CI（-5. 09 to 73. 58）,P = 0. 09]and the number of cleared lymph nodes[MD = 1,95% CI（-0. 67 to 2. 67）,P = 0. 24]. Conclusion Compared with L-LAR,R-LAR produces more favorable postoperative and oncologic outcomes.

关 键 词：达芬奇机器人手术系统 腹腔镜手术 直肠癌 低位前切除术 META分析 

分 类 号：R61[医药卫生—外科学]