机器人、腹腔镜辅助与开腹直肠全系膜切除术治疗直肠癌临床疗效对比的网状Meta分析  

Efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision for rectal cancer: a network meta-analysis

作　　者：刘源 沈伟 田志强 张银超 陶国青 朱雁飞 宋国栋 曹嘉诚 黄宇康 宋晨 LIU Yuan;SHEN Wei;TIAN Zhiqiang;ZHANG Yinchao;TAO Guoqing;ZHU Yanfei;SONG Guodong;CAO Jiacheng;HUANG Yukang;SONG Chen(Department of General Surgery,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,P.R.China)

机构地区：[1]南京医科大学附属无锡人民医院普外科,江苏无锡214023

出　　处：《中国循证医学杂志》2022年第10期1134-1141,共8页Chinese Journal of Evidence-based Medicine

基　　金：无锡市卫健委项目(编号:M202168);无锡市卫健委中青年拔尖人才资助计划项目(编号:HB2020007)。

摘　　要：目的 系统评价机器人、腹腔镜辅助与开腹进行直肠全系膜切除术(TME)治疗直肠癌的临床疗效。方法 计算机检索PubMed、EMbase、The Cochrane Library和ClinicalTrials.gov数据库,搜集机器人、腹腔镜与开腹进行TME治疗直肠癌的队列研究,检索时限均从2016年1月至2022年1月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件和R软件进行网状Meta分析。结果 共纳入24个研究,包括12 348例患者。Meta分析结果显示,在纳入的3种手术方式中,机器人辅助TME在缩短住院时间、降低术后吻合口瘘、肠梗阻、术后总并发症发生率等方面效果较好,而在肿瘤周围淋巴结清扫数目方面差异无统计学意义。结论 机器人辅助TME在直肠癌根治性和手术近期预后方面较好,但具体采用何种手术方式,需临床医生结合实际,实现对直肠癌患者的个性化治疗。Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision(TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library,and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted,and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.

关 键 词：直肠全系膜切除术 腹腔镜 机器人 开腹手术 队列研究 网状Meta分析 

分 类 号：R735.37[医药卫生—肿瘤]