传统开放式肝切除与机器人辅助肝切除的有效性与安全性的Meta分析  

Systematic review and meta-analysis of the efficacy and safety of traditional open liver resection and robot-assisted liver resection

作　　者：常建华 徐博文 赵伟[1] 谢同辉 赵丹文 陈志强[1] 智绪亭[1] CHANG Jian-hua;XU Bo-wen;ZHAO Wei;XIE Tong-hui;ZHAO Dan-wen;CHEN Zhi-qiang;ZHI Xu-ting(Department of Hepatobiliary Surgery,Qilu Hospital,the First Clinical Medical College of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院肝胆外科,山东济南250012

出　　处：《中国现代普通外科进展》2022年第9期707-713,共7页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:评价机器人辅助(PH)与开放式肝切除(OH)治疗肝脏疾病的有效性及安全性。方法:计算机检索PubMed、Scopus、Embase、Medline、Cochrane Library、中国期刊全文数据库(CNKI)和万方数据库(Wanfang Data)中相关领域的文章,研究类型限定为临床研究,检索时间截至2020年2月28日。以“机器人”“外科手术,计算机辅助”“肝切除术”为中文主题词,“Robotics”“Robotic Surgical Procedures”“Surgery,Computer Assisted”“Hepatectomy”作为英文主题词,采用主题词与自由词相结合的方式系统检索上述数据库。使用RevMan5.3、Stata12.0软件对结果进行统计分析。结果:共纳入8篇文献,均为回顾性非随机对照研究,共计962例患者,其中OH组575例,RH组387例。Meta分析结果显示,与OH组相比,RH组有更长的手术时间(MD=-48.76,95%CI:-95.55~-1.980,P=0.04)、更低的住院时间(MD=2.55,95%CI:1.89~3.22,P<0.0001)、总体费用(MD=0.50,95%CI:0.25~0.74,P<0.0001,I2=0%)、术中估计出血量(MD=61.00,95%CI:38.74~309.71,P=0.01),以及更少的术后总体并发症(RR=1.64,95%CI:1.22~2.19,P=0.001)和术后轻微并发症(Clavien-DindoⅠ~Ⅱ)(RR=1.49,95%CI:1.04~2.14)发生率。而在R0切除率、术后严重并发症(Clavien-DindoⅢ~Ⅴ)、术后出血方面两组间差异无统计学意义(P>0.05)。结论:RH有着与OH相同的安全性,但更短的住院时间能够弥补手术本身的高昂花费,从而使总体费用更低,RH可能是一种更安全有效的手术方式。Objective:Evaluate the efficacy and safety of robotic assisted hepatectomy and open hepatectomy by the means of meta-analytical techniques.Methods:Searched all the related published in Pubmed,Scopus,Embase Medline,Cochrane Library,CNKI and Wan Fang Data.The searches limited to clinical studies.The searching cut-off date was 2020/02/28.Using"Robot","Surgery","Computer-Assisted"and"Hepatectomy"as the Chinese subject terms,"Robotics""Robotic Surgical Procedures""Surgery,Computer Assisted"and"Hepatectomy"were used as English subject terms to systematically search the above database by combining subject terms and free terms.All the data obtained were statistically analyzed by using RevMan5.3 and Stata12.0 software recommended by Cochrane Collaboration.Results:A total of eight articles,involving 962 patients were enrolled in meta-analysis.Among them,575 cases underwent OH,and 387 cases underwent RH.?Compared with OH,the RH have longer operation time[MD=-48.76,95%CI(-95.55,-1.980),P=0.04],shorter hospital stay[MD=2.55,95%CI(1.89,3.22),P<0.0001],lesser total-cost[MD=0.50,95%CI(0.25,0.74),P<0.0001,I2=0%],and estimated bleeding during operation[MD=61.00,95%CI(38.74,309.71),P=0.01],total postoperative complications[RR=1.64,95%CI(1.22,2.19),P=0.001],and postoperative minor complications(Clavien DindoⅠ-Ⅱ)[RR=1.49,95%CI(1.04,2.14)].There were no significant differences between the two groups in the R_(0) resection rate,severe postoperative complications(Clavien DindoⅢ-Ⅳ)and postoperative bleeding.Conclusion:Robotic assisted hepatectomy are as safe as open hepatectomy,shorter hospital stay can make up for the high cost of robotics,resulting in lower overall costs.To sum up,robotic assisted hepatectomy is a new safe and effective surgical method.

关 键 词：机器人辅助肝切除 开放式肝切除 META分析 

分 类 号：R735.7[医药卫生—肿瘤]