达芬奇机器人与腹腔镜全直肠系膜切除术对泌尿与生殖功能影响的Meta分析  

Meta-analysis of effect of Da Vinci robot and laparoscopic total mesorectal excision on urinary and reproductive function

作　　者：李永柏 张东兴[1] 张忠民[1] 王润华[1] 罗辉 耿兴隆 杨晓飞[1] LI Yongbai;ZHANG Dongxing;ZHANG Zhongmin;WANG Runhua;LUO Hui;GENG Xinglong;YANG Xiaofei(Department of Gastrointestinal Surgery,Guizhou Provincial People's Hospital,Guizhou Guiyang 550000,China)

机构地区：[1]贵州省人民医院胃肠外科,贵州贵阳550000

出　　处：《现代肿瘤医学》2025年第6期946-954,共9页Journal of Modern Oncology

基　　金：国家自然科学基金资助项目(编号:82303337)。

摘　　要：目的:分析达芬奇机器人与腹腔镜下直肠癌全直肠系膜切除术后患者泌尿与生殖功能影响的差异。方法:计算机检索Cochrane Library、MEDLINE、PubMed、万方中文数据库、中国知网(CNKI)、维普期刊网中机器人与腹腔镜直肠癌术后泌尿与生殖功能相关临床研究文献,为扩大范围,手工检索相关文献的参考文献,检索日期限于建库至2024年2月29日。由两名研究者按照纳入与排除标准筛选文献,并进行文献质量评价和数据资料提取。对纳入文献进行综合分析;采用Review Manager 5软件进行Meta分析。结果:最终纳入26篇临床研究文献,共5429例患者,其中行达芬奇机器人直肠癌手术2709例(机器人组),行腹腔镜直肠癌手术2720例(腹腔镜组)。统计学分析显示:机器人组在术后30天内尿潴留发生率低于与腹腔镜组,差异具有统计学意义[RR=0.78,95%CI(0.61,0.99),P=0.04];这种差异并没有继续向远期延伸,术后30天以上机器人组和腹腔镜组尿潴留发生率相比差异无统计学意义[RR=0.65,95%CI(0.21,2.05),P=0.46];术后6月机器人组和腹腔镜组勃起功能障碍发生率相比差异无统计学意义[RR=0.77,95%CI(0.55,1.07),P=0.12];术后3月时,机器人组IPSS评分低于腹腔镜组,差异具有统计学意义[MD=-1.58,95%CI(-3.10,-0.05),P=0.04];术后12月时,两组手术方式的患者IPSS评分都逐渐降低,均低于术前,机器人组IPSS评分低于腹腔镜组,差异具有统计学意义[MD=-1.26,95%CI(-2.09,-0.44),P=0.003];术后12月时,机器人组IIEF-5评分高于腹腔镜组,差异具有统计学意义[MD=4.06,95%CI(2.38,5.74),P<0.00001];术后12月时,机器人组FSFI-15评分高于腹腔镜组,差异无统计学意义[MD=-0.59,95%CI(-2.00,0.82),P=0.41]。结论:达芬奇机器人与腹腔镜手术相比在直肠癌患者术后的泌尿生殖功能保护方面具有一定优势。Objective:To analyze the difference of urinary and reproductive function between Da Vinci robot and laparoscopic total mesorectal excision for rectal cancer.Methods:A computer-based online databases,including Cochrane Library,MEDLINE,PubMed in English,and Wanfang,CNKI and VIP Chinese journal net in Chinese were used to identify relevant literature on urinary and reproductive function after robotic and laparoscopic surgery for rectal cancer.The reference lists of the retrieved studies were also hand-searched for additional articles.The search date was limited to the period from the database establishment to February 29,2024.Two researchers screened the literatures according to the inclusion and exclusion criteria,and evaluated the quality of literature and extracted the data.Selective trials were analyzed by the Review Manager 5 software.Results:Finally,26 clinical studies were included,with a total of 5429 patients,including 2709 cases of Da Vinci robotic rectal cancer surgery(robotic group)and 2720 cases of laparoscopic rectal cancer surgery(laparoscopic group).Statistical analysis showed that the incidence of urinary retention within 30 days after surgery in the robotic group was lower than that in the laparoscopic group,and the difference was statistically significant[RR=0.78,95%CI(0.61,0.99),P=0.04].There was no significant difference in the incidence of urinary retention between the robotic group and the laparoscopic group over 30 days after surgery[RR=0.65,95%CI(0.21,2.05),P=0.46].There was no significant difference in the incidence of erectile dysfunction between the robotic group and the laparoscopic group at 6 months after surgery[RR=0.77,95%CI(0.55,1.07),P=0.12].At 3 months after surgery,the IPSS score of the robotic group was lower than that of the laparoscopic group,and the difference was statistically significant[MD=-1.58,95%CI(-3.10,-0.05),P=0.04].At 12 months after surgery,the IPSS scores of the two groups were decreased gradually,which were lower than those before surgery.The IPSS score of the rob

关 键 词：腹腔镜 直肠手术 机器人 泌尿系功能 性功能 

分 类 号：R735.37[医药卫生—肿瘤]