机器人辅助胸腔镜食管癌切除术对比传统胸腔镜食管癌切除术的安全性与有效性的系统评价与Meta分析  

Safety and efficacy of robot-assisted minimally invasive esophagectomy and the conventional minimally invasive esophagectomy:a Meta-analysis and systematic review

作　　者：金大成 苟云久[1] 于珺[1] 柏启洲 贺生亮[1] 郭天康[3] 杨克虎[3,4,5] 姚亮 刘荣[4] JIN Dacheng;GOU Yunjiu;YU Jun;BAI Qizhou;HE Shengliang;GUO Tiankang;YANG Kehu;YAO Liang;LIU Rong(Department of Thoracic Surgery,Gansu Provincial People’s Hospital,Lanzhou 730000,Gansu,China;School of Clinical Medicine,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,Gansu,China;Institution of Clinical Research and Evidence-Based Medicine,Gansu Provincial People’s Hospital,Lanzhou 730000,Gansu,China;Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,Gansu,China;Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Transformation,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃省人民医院胸外科,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循证医学研究所,兰州730000 [4]兰州大学循证医学中心,兰州730000 [5]甘肃省循证医学与临床转化重点实验室,兰州7300000

出　　处：《癌症进展》2019年第9期1019-1024,共6页Oncology Progress

基　　金：甘肃省人民医院院内科研基金(16GSSY3-1)

摘　　要：目的系统评价机器人辅助微创食管切除术(RAMIE)与传统视频辅助微创食管切除术(MIE)的有效性及安全性。方法计算机检索PubMed、荷兰医学文摘(EMBASE)、Cochrane Library和中国生物医学文献数据库(CBM),搜集关于RAMIE与MIE的临床研究,搜索时限为建库至2017年12月。由两名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险,采用R3.4.2软件进行Meta分析。结果纳入7项病例对照研究,包括1840例食管癌患者,其中接受RAMIE和MIE治疗的患者各920例。Meta分析结果显示,接受RAMIE治疗的患者术后30天病死率高于接受MIE治疗的患者[比值比(OR)=1.80,95%CI:1.03～3.14;P=0.04];两种手术治疗患者的淋巴结清扫比例[平均偏差(MD)=0.98枚,95%CI:-0.63～2.59]、总手术时间(MD=-9.06 min,95%CI:-33.75～15.63)、胸部手术时间(MD=21.48 min,95%CI:-11.46～54.42)、术中出血量(MD=-19.60 ml,95%CI:-41.29～2.08)、术后住院时间(MD=-1.95 d,95%CI:-5.00～1.10)、R0切除率(OR=1.11,95%CI:0.68～1.79)和总体并发症的发生率(OR=0.79,95%CI:0.46～1.38)比较,差异均无统计学意义(P﹥0.05)。结论 RAMIE与MIE的安全性及有效性基本一致。在统计学上,接受RAMIE治疗的患者术后30天病死率高于接受MIE治疗的患者。随着微创技术的发展,RAMIE将使更多的患者获益。Objective This meta-analysis aims to assess the safety and efficacy of robot-assisted minimally invasive esophagectomy(RAMIE)versus conventional minimally invasive esophagectomy(MIE)in patients with esophageal cancer.Method PubMed,EMBASE,Cochrane library,and China Biology Medicine(CBM)databases were systematically searched as of December,2017 for case-controlled studies comparing RAMIE and MIE.Two independent investigators were responsible for literature screening,data mining and evaluating the risk of bias when including candidate researches,and R3.4.2 software was used to perform the Meta-analysis.Result A total of 7 case-controlled studies involving 1840 patients(920 receiving RAMIE and 920 receiving MIE)were included.The meta-analysis indicated that,the 30-day mortality rate after surgery of patients receiving RAMIE was significantly higher than that in those who were treated by MIE[odds ratio(OR)=1.80,95%CI:1.03-3.14;P=0.04)];there were no statistically significant differences between the two groups in regard of number of dissected lymph nodes(MD=0.98,95%CI:-0.63-2.59),overall operative time(MD=-9.06 min,95%CI:-33.75-15.63),thoracic operative time(MD=21.48 min,95%CI:-11.46-54.42),intraoperative estimated blood loss(MD=-19.60 ml,95%CI:-41.29-2.08),postoperative hospital stay(MD=-1.95 d,95%CI:-5.00-1.10),and R0 resection rate(OR=1.11,95%CI:0.68-1.79),and incidence of complications(OR=0.79,95%CI:0.46-1.38)(all P>0.05).Conclusion Generally speaking,the safety and efficacy of RAMIE is similar to that of MIE,though the 30-day mortality observed with RAMIE is higher than MIE statistically.With the development of robot-assisted techniques,RAMIE will benefit an increasing number of patients.

关 键 词：机器人辅助 食管切除术 系统评价 META分析 

分 类 号：R735.1[医药卫生—肿瘤]