机器人与腹腔镜手术治疗胃癌的近期疗效对比Meta分析

Robotic versus laparoscopic gastrectomy for gastric cancer:a Meta-analysis of short-term results

目的:系统评价机器人胃切除术(RG)治疗胃癌的安全性、有效性和近期疗效。方法:检索国内外数据库,收集2005年1月—2015年1月间发表的对比RG和腹腔镜胃切除术(LG)治疗胃癌近期疗效的中文和英文文献,使用Rev Man 5.3软件进行Meta分析。结果:最终纳入15篇文献,共计5 286例胃癌患者,其中RG组1 618例,LG组3 668例。Meta分析结果显示,与LG组比较,RG组术中出血量明显减少(WMD=-38.79,95%CI=-53.73^-23.84),淋巴结清扫数目多(WMD=2.13,95%CI=1.45~2.80),胃肠功能恢复时间、进食时间和术后住院时间缩短(WMD=-0.27,95%CI=-0.37^-0.16;WMD=-0.25,95%CI=-0.37^-0.14;WMD=-0.82,95%CI=-1.32^-0.32),但手术时间明显延长(WMD=37.39,95%CI=26.79~47.98)(均P<0.05)。两组近端切缘距离、远端切缘距离和术后并发症发生率方面的差异无统计学意义(WMD=0.05,95%CI=-0.11~0.20;WMD=0.30,95%CI=-0.28~0.88;OR=0.97,95%CI=0.79~1.19)(均P>0.05)。结论:RG治疗胃癌安全可行,可取得与LG相当或更佳的近期疗效和肿瘤根治效果。

Objective：To systematically evaluate the safety,efficacy and short-term results of robotic gastrectomy（RG） for gastric cancer.Methods：The literature in both Chinese and English regarding studies comparing RG and laparoscopic gastrectomy（LG） published between January 2005 and January 2015 were searched from national and international databases.Meta-analysis was performed by using Rev Man 5.3 sot ware.Results：Fit een studies were finally included involving 5 286 patients,of whom 1 618 cases underwent RG（RG group） and 3 668 cases underwent LG（LG group）.Results of Meta-analysis indicated that in RG group compared with LG group,the intraoperative blood loss was signii cantly reduced（WMD=–38.79,95% CI=–53.73––23.84）,number of dissected lymph nodes was increased（WMD=2.13,95% CI=1.45–2.80）,time to first flatus and oral intake,and length of hospital stay were shortened（WMD=–0.27,95% CI=-0.37––0.16; WMD=–0.25,95% CI=–0.37––0.14; WMD=–0.82,95% CI=–1.32––0.32）,but the operative time was signii cantly prolonged（WMD=37.39,95% CI=26.79–47.98）（all P〈0.05）.h ere was no signii cant dif erence in the length of proximal and distal resection margin,or incidence of postoperative complications between the two groups（WMD=0.05,95% CI=–0.11–0.20; WMD=0.30,95% CI=–0.28–0.88; OR=0.97,95% CI=0.79–1.19）（all P〉0.05）.Conclusion：RG is safe and feasible in treatment of gastric cancer,and can achieve comparable or bet er shortterm and radical ef ect than LG.