机器人和腹腔镜直肠癌根治术近期疗效的Meta分析  

Short term efficacy of robotic versus laparoscopic surgery for rectal cancer:a meta-analysis

作　　者：王素[1] 孙振青[2] 刘小雷[2] 苏萌萌[2] 王东升[2] 种瑞峰[1] Wang Su;Sun Zhenqing;Liu Xiaolei;Su Mengmeng;Wang Dongsheng;Chong Ruifeng(Department of General Surgery,the Fifteenth Clinical College of Qingdao University,Qingdao 266109,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学第十五临床医学院普外科,266109 [2]青岛大学附属医院胃肠外科,266003

出　　处：《中华结直肠疾病电子杂志》2021年第5期505-513,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的通过Meta分析的方法比较机器人直肠癌根治术与腹腔镜直肠癌根治术的安全性、可行性与近期疗效。方法检索包括Pubmed、EMBASE、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据、维普数据库在内的数据库。检索时间为建库至2020年3月。用NOS评分系统评价文献质量。用Review Manager 5.3软件进行统计分析。结果最终纳入符合标准的相关文献9篇,纳入患者1527例,其中达芬奇机器人辅助直肠癌根治术(RP)组786例(51.5%)、腹腔镜辅助直肠癌根治术(LP)组741例(48.5%)。分析结果显示:与LP组相比,RP组手术时间长(WMD=36.74,95%CI=7.84~65.64,P=0.01<0.05),RP组平均术中失血量少(WMD=-20.92,95%CI=-34.56~-7.28,P=0.003),平均住院时间缩短(WMD=0.85,95%CI=-1.37~-0.33,P=0.001),中转开腹率低(WMD=0.44,95%CI=0.20~0.98,P=0.04)。在淋巴结获取数目、肿瘤距远端切缘距离、术后首次排气时间、造口率、术后并发症总发生率等方面两组间差异均无统计学意义(均P>0.05)。结论机器人直肠癌根治术可减少术中失血量、降低中转开腹率、缩短平均住院时间,但在淋巴结获取数目、肿瘤距远端切缘距离、术后首次排气时间、造口率、术后并发症总发生率等方面无明显优势。Objective A meta-analysis was conducted to evaluate and compare the safety,feasibility and short-term efficacy between robotic and laparoscopic radical resection of rectal cancer.Methods A literature search was performed including Pubmed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database(CBM),Chinese CNKI,Wanfang and VIP database.The retrieval time was set up to March 2020.NOS score system was used to evaluate literature quality.Statistical analysis was performed using Review Management 5.3 software.Results There were 9 relevant literatures that matched the standards,a total of 1527 patients were included.There were 786 cases(51.5%)in RP group and 741 cases(48.5%)in LP group.The results showed that compared with LP group,RP group had a longer operative time(WMD=36.74,95%CI=7.84~65.64,P=0.01<0.05),less intraoperative blood loss(WMD=-20.92,95%CI=-34.56~-7.28,P=0.003),shorter average length of hospital stay(WMD=0.85,95%CI=-1.37~0.33,P=0.001),and lower conversion rate(WMD=0.44,95%CI=0.20~0.98,P=0.04).There were no statistically significant differences between the two groups in the number of lymph nodes acquired,the distance between the tumor and the distal cutting edge,the time of first postoperative exhaust,the rate of stoma,and the total incidence of postoperative complications(all P>0.05).Conclusion The robotic of rectal cancer can reduce intraoperative blood loss,reduce the rate of conversion rate,and shorten the average hospital stay,but it has no obvious advantages in the number of lymph nodes acquired,the distance between tumor and distal resection margin,the time of first postoperative exhaust,the rate of stoma,and the total incidence of postoperative complications.

关 键 词：直肠肿瘤 机器人 腹腔镜 META分析 

分 类 号：R735.37[医药卫生—肿瘤]