机器人辅助与腹腔镜肝切除术治疗肝肿瘤有效性和安全性的Meta分析  

Efficacy and safety of robotic-assisted versus laparoscopic hepatectomy for hepatic neoplasms: a meta-analysis

作　　者：胡立冬 姚亮[3] 田宏伟[1] 李小飞 靳鹏辉 李惠民 杨克虎[3,5] 刘荣[6] 郭天康[1,2,3,4] 

机构地区：[1]甘肃省人民医院普外科,兰州730000 [2]甘肃中医药大学临床医学院,兰州730000 [3]甘肃省人民医院临床研究与循证医学研究所,兰州730000 [4]宁夏医科大学临床医学院,银川750001 [5]兰州大学循证医学中心,兰州730000 [6]中国人民解放军总医院肝胆外二科,北京100853

出　　处：《中国循证医学杂志》2018年第3期334-341,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价机器人辅助肝切除术(robotic-assisted hepatectomy,RAH)与腹腔镜肝切除术(traditional laparoscopic hepatectomy,TLH)比较治疗肝肿瘤的安全性和有效性。方法计算机检索Pub Med、EMbase、The Cochrane Library、Web of science、CNKI、Wan Fang Data和CBM数据库,搜集RAH与TLH比较治疗肝肿瘤的队列研究,检索时限均从建库至2016年12月10日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入17个研究,包括1 389名患者。Meta分析结果显示:与TLH比较,RAH术中失血更多[WMD=39.56,95%CI(4.65,74.47),P=0.013]、手术时间更长[SMD=0.55,95%CI(0.29,1.45),P<0.001]、术后首次进食时间更晚[SMD=1.06,95%CI(0.66,1.45),P<0.001]。但两组在住院时间、术中中转开腹率、术中输血率、肿瘤切缘切除率、并发症及90天死亡率方面差异均无统计学意义。结论当前证据表明,TLH在手术时间、术中失血量和首次进食时间上优于RAH,但在主要结局指标方面,两组差异无统计学意义,提示RAH和TLH在肝肿瘤切除术中有着相似的有效性和安全性。受纳入研究质量的限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the efficacy and safety of robotic-assisted hepatectomy （RAH） versus traditional laparoscopic hepatectomy （TLH） for hepatic neoplasms. Methods Databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and CBM databases were electronically searched to collect cohort studies about the RAH vs. the TLH for liver neoplasms from inception to December 10th, 2016. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And finally, a meta-analysis was performed by using RevMan 5.3 software. Results A total of 17 studies involving 1 389 patients were included. The meta-analysis results showed that： compared to TLH group, RAH group was associated with more estimated blood loss （WMD=39.56, 95%CI 4.65 to 74.47, P=0.013）, longer operative time SMD=0.55, 95%CI 0.29 to 0.80, P〈0.001）, and later in the first nutritional intake time （SMD=I.06, 95%CI 0.66 to 1.45, P〈0.001）. However, there were no significant differences in the length of hospital stay, conversion to laparotomy, intraoperative blood transfusion, resection rate of tumor margin, complications and 90-day mortality between the two groups. Conclusion Current evidence indicates that TLH is superior to RAH in terms of operative time, intraoperative blood loss and the first nutritional intake time, but there are no statistically significant differences in the primary outcomes, suggesting that RAH and TLH have similar efficacy and safety for hepatic neoplasms. Due to the limitation of quality and quantity of the included studies, the above conclusions need to be verified by more high-quality research.

关 键 词：肝肿瘤 机器人辅助 腹腔镜 肝切除术 META分析 系统评价 队列研究 

分 类 号：R735.7[医药卫生—肿瘤]