机器人与腹腔镜胃癌手术近期疗效的Meta分析  

Meta-analysis of short term effect of conventional laparoscopic versus robotic surgery for gastric cancer

作　　者：江伟东 李永翔[1] 鲁明典[1] 闫强[1] 张尚鑫[1] 孙若川 李德关 

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230032

出　　处：《安徽医学》2017年第6期686-691,共6页Anhui Medical Journal

基　　金：安徽省高校自然科学研究项目(项目编号:KJ2016A329);安徽省科技计划项目(项目编号:1704A0802167)

摘　　要：目的检索国内外文献,利用高质量文献探讨达芬奇手术机器人与传统腹腔镜治疗胃癌的疗效差异。方法检索自2002年1月1日至2016年12月31日发表的关于对比机器人及传统腹腔镜手术治疗胃癌的前瞻性文献,并利用改良MINORS评分筛选高质量文献,评价指标包括手术时间、失血量、住院时间、并发症、淋巴结数目、切缘情况。结果共纳入13篇前瞻性文献,共纳入病例5 378例(腹腔镜组3 813例,机器人组共1 565例),样本量范围为27~1 297例,两组患者手术并发症发生率差异无统计学意义(OR=1.08,95%CI:0.88~1.32,P>0.05),术后肠梗阻、切口感染、吻合口瘘的发生率及术后30 d内病死率差异无统计学意义(P>0.05)。腹腔镜组手术时间优于机器人组,差异有统计学意义(MD=-41.03,95%CI:-53.75^-28.31,P<0.05),机器人组的术中失血量却少于传统腹腔镜组,差异有统计学意义(MD=25.22,95%CI:8.28~42.15,P<0.05),腹腔镜组所获取的淋巴结数目少于机器人组,差异有统计学意义(MD=-2.20,95%CI:-3.26^-1.15,P<0.05)。而在近端切缘及远端切缘方面,两组差异无统计学意义(P>0.05)。结论机器人手术与腹腔镜手术均能够达到胃癌根治的效果,腹腔镜手术在手术时间方面优势明显,而机器人胃癌手术在术中失血量、淋巴结的清除数目方面取得了更好的效果。Objective To present a meta-analysis of high-quality published reports comparing conventional laparoscopic gastric cancer resection （LR） and robotic gastric cancer resection （RR）.Methods Studies that compared LR and RR and were published from 2002 to 2016 were identified.All eligible trials were evaluated based on the modified Methodological Indices for Nonrandomized Studies （MINORS）.The mean differences （MD） and odds ratios （OR） were used to compare the operative time, blood loss, mortality, complications, harvested lymph nodes, hospital stay, resection margin.Results Twelve studies enrolled ranging from 27 to 1 297 patients were identifiedand 5 008 patients （3 813 LR, 1 565 RR） were included.There was no significant difference between the two groups（OR=1.08,95%CI：0.88~1.32,P〉0.05） in the incidence of complications.Although the operation time of the RR group was obviously longer than that of the conventional surgery group （MD=-41.03,95%CI：-53.75^-28.31,P〈0.05）, RR was associated with less blood loss（MD=25.22,95%CI：8.28~42.15,P〈0.05） and more harvested lymph nodes（MD=-2.20,95%CI：-3.26^-1.15,P〈0.05）.However, no significant differences between the LR and RR groups were observed in terms of the mortality, hospital stay,resection margin.Conclusion RR can be performed safely compared with conventional surgery.The traditional laparoscopic surgery has obvious advantages in operation time and the robotic gastric cancer surgery has a better effect in the number of blood loss and the harvested lymph nodes.

关 键 词：META分析 胃癌 腹腔镜手术 机器人手术 

分 类 号：R735.2[医药卫生—肿瘤]