机器人辅助腹腔镜与传统腹腔镜行胰腺癌手术的Meta分析  

Meta-analysis of robot assisted laparoscopic and conventional laparoscopic surgery for pancreatic cancer

作　　者：薛瑞华[1] 

机构地区：[1]解放军总医院肿瘤外二科,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2016年第1期19-24,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的本研究旨在系统评价机器人辅助腹腔镜手术在胰腺癌手术治疗中应用的可行性与安全性,为临床研究与实践提供参考。方法计算机检索Pub Med、中国知网和万方,同时辅以其他检索,收集所有机器人辅助腹腔镜和传统腹腔镜应用于胰腺癌手术治疗的比较研究。按照Cochrane系统评价纳入文献的质量,利用Stata 12.0软件对提取的相关指标进行Meta分析。结果8篇文献纳入Meta分析,包含682例胰腺癌患者,其中机器人辅助治疗组292例,传统腹腔镜组390例。Meta分析结果表明:与传统腹腔镜手术相比,机器人辅助腹腔镜手术能够减少术中出血量(SMD=-0.670,95%CI=-1.012,-0.329),降低输血率(RR=0.457,95%CI=0.245,0.854)和术中转开腹率(RR=0.612,95%CI=0.348,0.974),提高保脾率(RR=2.331,95%CI=1.599,3.398),缩短术后住院时间(SMD=-0.230,95%CI=-0.433,-0.027),并且能够减少术后并发症(RR=0.643,95%CI=0.451,0.917)和再次手术率(RR=0.766,95%CI=0.258,2.268)。但是,二者的手术时间和术后胰瘘率无显著性差异。结论机器人辅助腹腔镜手术相对于传统腹腔镜手术,术中出血量少,转开腹率低,保脾率高,并发症少,再次手术率低,可以安全有效地治疗胰腺癌。Objective The purpose of the meta-analysis was to assess the safety and efficacy of robotic surgery for pancreatic cancer patients,compared with laparoscopic pancreatectomy. Methods Pub Med,Wanfang,CNKI（ China National Knowledge Infrastructure） were used for literature retrieval.Studies on comparison of robotic and laparoscopic pancreatectomy for pancreatic cancer were collected in the present study. The qualities of the included articles were evaluated by Cochrane assessment tool. Stata 12. 0software was applied to the present meta-analysis. Results 8 studies with 682 patients were included in this meta-analysis. 292 patients received robotic treatment,while 390 patients were treated with laparoscopic approach. Meta-analysis indicated that robotic surgery could significantly improve blood loss during the operation（ SMD =- 0. 670,95% CI =- 1. 012-- 0. 329）,the frequency of blood transfusion（ RR =0. 457,95% CI = 0. 245-0. 854）,conversion into open surgery（ RR = 0. 612,95% CI = 0. 348-0. 974）,and the rate of spleen preservation（ RR = 2. 331,95% CI = 1. 599-3. 398）. In addition,postoperative hospital stay（ SMD =- 0. 230,95% CI =- 0. 433-- 0. 027）,occurrence of complications（ RR = 0. 643,95% CI =0. 451-0. 917）,and reoperation rate（ RR = 0. 766,95% CI = 0. 258-2. 268） were significantly lower in robotic treatment group than that in the laparoscopic approach group. However,the pancreatic fistula and operative time were similar between the two groups. Conclusion Compared with laparoscopic approach,robotic pancreatectomy is safe and effective for patients with pancreatic cancer,which can be widely used in clinical practices.

关 键 词：机器人 腹腔镜 胰腺癌 META分析 

分 类 号：R735.9[医药卫生—肿瘤]