机器人与腹腔镜经括约肌间切除治疗低位直肠癌疗效比较的meta分析  

Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a metaanalysis

作　　者：李来元 杨熊飞[1] 冯丽莉[1] 果茵茵[2] 张洪来 徐世赟 吕耀春[1] 吴德望 陈一峰 张维胜[1] LI Laiyuan;YANG Xiongfei;FENG Lili;GUO Yinyin;ZHANG Honglai;XU Shiyun;LüYaochun;WU Dewang;CHEN Yifeng;ZHANG Weisheng(Department of Colorectal Surgery,Gansu Provincial Hospital,Lanzhou 730000,P.R.China;Department of Pharmacy,The Second Hospital of Lanzhou University,Lanzhou 730050,P.R.China)

机构地区：[1]甘肃省人民医院肛肠科,兰州730000 [2]兰州大学第二医院药剂科,兰州730050

出　　处：《中国普外基础与临床杂志》2019年第12期1445-1451,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：甘肃省科技计划项目（项目编号：18JR3RA055)

摘　　要：目的评价机器人腹腔镜经括约肌间切除术(intersphincteric resection,ISR)治疗低位直肠癌的临床疗效。方法检索中国生物医学文献数据库、中国知网、万方数据库、PubMed、Embase及Cochrane library的相关文献。检索时间为各数据库建库至2019年4月1日,用Review Manager 5.2软件对相关的指标进行meta分析。结果共有5篇文献510例患者纳入分析,其中机器人组273例,传统腹腔镜组237例。与腹腔镜组相比,机器人组的手术时间[MD=43.27,95%CI(16.48,70.07),P=0.002]增加、术中出血量[MD=–19.98.27,95%CI(–33.14,–6.81),P=0.003]减少、中转开腹率[MD=0.20,95%CI(0.04,–0.95),P=0.04]降低、淋巴结获取数目[MD=–1.71,95%CI(–3.21,–0.21),P=0.03]减少以及住院时间[MD=–1.61,95%CI(–2.26,–0.97),P<0.00001]缩短,其差异均具有统计学意义。但术后肛门排气时间[MD=–0.01,95%CI(–0.48,0.46),P=0.96]、进食时间[MD=–0.20,95%CI(–0.67,0.27),P=0.41]、并发症发生率[OR=0.76,95%CI(0.50,1.14),P=0.18]、肿瘤距远切缘距离[MD=0.00,95%CI(–0.17,0.17),P=0.98]以及环周切缘阳性率[OR=0.61,95%CI(0.27,1.37),P=0.23]与腹腔镜组比较,差异均无统计学意义。结论机器人和腹腔镜ISR治疗低位直肠癌显示了相似的围手术期结果;尽管机器人ISR手术时间更长、淋巴结获取数目更少,但术中出血更少、中转开腹率更低以及住院时间更短。机器人ISR是一种安全有效的治疗低位直肠癌的技术。Objective To evaluate the efficacy of robotic intersphincteric resection(ISR)for rectal cancer.Methods A literature search was performed using the China biomedical literature database,Chinese CNKI,Wanfang,PubMed,Embase,and the Cochrane library.The retrieval time was from the establishment of databases to April 1,2019.Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.Results A total of 510 patients were included in 5 studies,including 273 patients in the robot group and 237 patients in the laparoscopic group.As compared to the laparoscopic group,the robot group had significantly longer operative time[MD=43.27,95%CI(16.48,70.07),P=0.002],less blood loss[MD=–19.98.27,95%CI(–33.14,–6.81),P=0.003],lower conversion rate[MD=0.20,95%CI(0.04,–0.95),P=0.04],less lymph node harvest[MD=–1.71,95%CI(–3.21,–0.21),P=0.03]and shorter hospital stay[MD=–1.61,95%CI(–2.26,–0.97),P<0.00001].However,there were no statistically significant differences in the first flatus[MD=–0.01,95%CI(–0.48,0.46),P=0.96],time to diet[MD=–0.20,95%CI(–0.67,0.27),P=0.41],incidence of complications[OR=0.76,95%CI(0.50,1.14),P=0.18],distal resection margin[MD=0.00,95%CI(–0.17,0.17),P=0.98]and positive rate of circumferential resection margin[OR=0.61,95%CI(0.27,1.37),P=0.23].Conclusions Robotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes.Compared with laparoscopic ISR,robotic ISR has the advantages of less blood loss,lower conversion rate,and longer operation times.These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.

关 键 词：腹腔镜手术 机器人手术 经括约肌间切除术 低位直肠癌 

分 类 号：R73[医药卫生—肿瘤]