机器人辅助与传统腹腔镜胆囊切除术治疗良性胆囊疾病疗效比较的Meta分析  

Meta-analysis of robotic-assisted versus conventional laparoscopic cholecystectomy for benign gallbladder diseases

作　　者：韩彩文 姚亮[3,4] 闫沛静 李美萱 金大成 蔡辉 杨克虎[3,5] 刘荣[7] 郭天康[1,3,5] HAN Caiwen;YAO Liang;YAN Peijing;LI Meixuan;JIN Dacheng;CAI Hui;YANG Kehu;LIU Rong;GUO Tiankang(Department of General Surgery,People＇s Hospital of Gansu Province,Lanzhou 730000,China;Department of Clinical Medicine,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China;Institution of Clinical Research and Evidence-Based Medicine,Gansu Provincial Hospital,Lanzhou 730000,China;School of Chinese Medicine,Hong Kong Baptist University,Hong Kong Special Administrative Region 999077,China;Center for Evidence-Based Medicine,Lanzhou University,Lanzhou 730000,China;School of Public Health,Lanzhou University,Lanzhou 730000,China;Department of Hapetopancreatobiliary Oncological Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]甘肃省人民医院普通外科,甘肃兰州730000 [2]甘肃中医药大学临床医学院,甘肃兰州730000 [3]甘肃省人民医院临床研究与循证医学研究所,甘肃兰州730000 [4]香港浸会大学中医药学院,中国香港9990773 [5]兰州大学循证医学中心,甘肃兰州730000 [6]兰州大学公共卫生学院,甘肃兰州730000 [7]中国人民解放军总医院肝胆胰肿瘤外科,北京100853

出　　处：《中国普通外科杂志》2018年第8期955-967,共13页China Journal of General Surgery

基　　金：甘肃省循证医学与临床转化重点实验室基金资助项目(lcxz006);甘肃省兰州市科技局指导性计划基金资助(2017-ZD-38)

摘　　要：目的:比较机器人辅助腹腔镜胆囊切除术(RAC)与传统腹腔镜胆囊切除术(TLC)治疗良性胆囊疾病的疗效。方法:系统检索文献数据库,按照纳入、排除标准筛选符合标准的文献,用Rev Man5.3软件进行Meta分析。结果:纳入26篇文献,共4004例患者,其中1833例行RAC,2171例行TLC。Meta分析结果显示,与TLC比较,RAC的手术时间延长(MD=13.14,95%CI=4.79~21.50,P=0.002)、切口疝发生率升高(RR=3.59,95%CI=1.77~7.28,P=0.0004)、术中中转开腹率降低(RR=0.60,95%CI=0.40~0.92,P=0.02)。而在术中并发症、术后并发症、30d再入院率、住院时间、失血量等方面,两者之间均无统计学差异(均P>0.05)。结论:当前的证据表明,RAC具有与TLC相似的安全性和有效性但并不比TLC有优势。Objective： To compare the clinical efficacy of robotic-assisted cholecystectomy（RAC） and traditional laparoscopic cholecystectomy（TLC） in treatment of benign gallbladder diseases.Methods： After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria. After data extraction, Meta-analysis was performed by using RevM an 5.3 software. Results： Twenty-six studies were finally included, involving 4 004 patients, of whom, 1 833 cases underwent RAC and 2 171 cases underwent TLC. The results of Meta-analysis showed that RAC had prolonged operative time（MD=13.14, 95% CI=4.79–21.50, P=0.002） and increased incidence of incisional hernia（RR=3.59, 95% CI=1.77–7.28, P=0.0004）, but reduced intraoperative conversion rate（RR=0.60, 95% CI=0.40–0.92, P=0.02） compared with TLC. However, no significant differences were found in intraoperative complications, postoperative complications, 30 d readmission rate, length of hospital stay and blood loss between the two procedures（all P〉0.05）. Conclusion： Current evidence suggests that RAC has similar safety and effectiveness as TLC, but no advantage over TLC.

关 键 词：胆囊切除术 机器人手术 腹腔镜 META分析 

分 类 号：R657.4[医药卫生—外科学]