机器人辅助腹腔镜手术与传统开腹手术治疗子宫内膜癌效果对比的Meta分析  

Comparison between Robotic-assisted Laparoscopic Surgery and Traditional Open Surgery for Endometrial Cancer:A Meta-Analysis

作　　者：王夙斐 陈勇 王晓雯[1] 易村犍[1] WANG Sufei;CHEN Yong;WANG Xiaowen(The First Affiliated Hospital of Yangtze University The First People＇s Hospital of Jingzhou,Jingzhou Hubei 434000,Chin)

机构地区：[1]长江大学附属第一医院荆州市第一人民医院,湖北荆州434000

出　　处：《实用妇产科杂志》2018年第7期540-545,共6页Journal of Practical Obstetrics and Gynecology

基　　金：湖北省医学领军人才培养工程专项经费资助项目[编号:鄂卫生计生发(2013)4号]

摘　　要：目的:应用Meta分析对比机器人辅助腹腔镜手术(RS)与传统开腹手术(OS)在治疗子宫内膜癌的效果及安全性,进而指导临床的治疗。方法:计算机检索Pub Med,Medline,Cochrane Library Databases and Embase数据库,检索时间从建库到2017年4月止。收集期间公开发表的关于RS与OS在治疗子宫内膜癌疗效对比的文献,由两位研究员独立依照纳入和排除标准筛选文献、提取数据和进行文献质量评估后,利用Review Manager 5.3统计软件进行Meta分析。结果:共纳入27篇文献,涉及4440例患者,其中RS 1973例,OS 2467例。Meta分析结果显示RS与OS相比,术中出血量少(MD=-168.19,95%CI-190.51^-145.87,P<0.00001)、术后住院时间短(MD=-3.05,95%CI-3.43^-2.68,P<0.00001)、术中输血率低(OR=0.24,95%CI 0.16~0.36,P<0.00001)、术中并发症发生率低(OR=0.60,95%CI 0.39~0.94,P=0.02)、术后并发症发生率低(OR=0.39,95%CI0.25~0.60,P<0.0001)、总并发症发生率低(OR=0.28,95%CI 0.21~0.37,P<0.00001),再入院率低(OR=0.41,95%CI 0.27~0.64,P<0.0001),总生存率高(OR=2.15,95%CI 1.11~4.18,P=0.02),但手术时间延长(MD=40.72,95%CI 8.37~72.71,P=0.01)。盆腔淋巴结切除数目(MD=-1.13,95%CI-2.98~0.27,P=0.23)、腹主动脉淋巴结切除数目(MD=-0.28,95%CI-2.64~2.08,P=0.82)、总淋巴结切除数目(MD=0.43,95%CI-2.32~3.18,P=0.76)、无疾病生存率(MD=1.69,95%CI 0.68~4.21,P=0.26)无明显差异。结论:在子宫内膜癌的治疗中,RS比OS损伤小,患者恢复快,安全性和有效性更高。Objective：To compare the clinical outcomes of robotic-assisted laparoscopic surgery（RS） and traditional open surgery（OS） for endometrial cancer by conducting a Meta-analysis to guide the choice of clinical operation. Methods： PubMed, MEDLINE, Cochrane Library Databases and Embase were searched. The literatures comparing RS with OS in endometrial cancer published from the built of the databases to April 2017 were collected. After screening for literature, data extraction and quality assessment were conducted independently by two reviewers, and the statistical analysis were made with Review Manager 5.3. Results：There were twenty-five studies including 4440 patients meeting the eligibility criteria. Among them,1973 patients underwent RS and 2467 underwent OS. Compared to OS, RS experienced less estimated blood loss （MD = -168. 19, 95% CI = -190.51 - - 145.87, P 〈 0. 00001 ）, shorter hospital stay（MD = - 3.05,95% CI = - 3.43 - - 2.68, P 〈 0. 00001 ）, lower number of transfusions（ OR =0.24,95% CI = 0. 16 -0.36, P 〈 0. 00001 ）, lower number of intraoperative complications（ OR = 0.60,95% CI = 0.39 - 0.94, P = 0.02 ）, lower number of postoperative complications（ OR=0. 39,95%CI =0.25 -0.60,P〈0. 0001 ） ,lower number of total complications（ OR=0. 28,95%CI = O. 21 - 0. 37, P 〈 0. 00001 ）, lower Readmission （ OR = 0. 41,95% CI = 0. 27 - 0. 64, P 〈 0. 0001 ）, longer time of operation （ MD = 40.72,95% CI = 8.37 - 72.71, P = 0. 01 ）, longer overall survival （ OR = 2. 15,95% CI （ 1.11 - 4. 18）, P=0. 02）. We found no significant differences in total pelvic nodes harvested,total periaortic nodes harvested,total nodes harvested and disease-free survival. Conclusions：In the treatment of endometrial cancer, RS is less than OS damage,patients recover faster,safer and more effective.

关 键 词：机器人辅助腹腔镜手术 传统开腹手术 子宫内膜癌 META分析 

分 类 号：R711.74[医药卫生—妇产科学]