机器人与开腹行胰十二指肠切除术疗效的Meta分析

Robotic versus open pancreaticoduodenectomy: a meta-analysis

目的:通过分析已发表的关于机器人与开腹胰十二指肠切除术的文献,对两种手术方式的主要指标及次要指标进行Meta分析,评价其疗效。方法:检索2015年7月31日前发表在Pub Med、EMBASE及Cochrane Library上关于机器人与开腹行胰十二指肠切除术的临床文献。检索策略:检索词为"robotic*"or"robot-assisted"and("pancreaticoduodenectomy"or"pancreatic surgery")。采用Cochrane协作网专用软件Rev Man 5.3对数据进行Meta分析。共纳入5篇文献,其中临床对照研究4篇,对比研究1篇,共纳入患者426例,机器人组162例,开腹组264例。结果:机器人行胰十二指肠切除术有着不同的名称,如robot-assisted pancreaticoduodenectomy(RAPD),robot-assisted laparoscopic pancreaticoduodenectomy(RLPD),laparoscopic robotic-assisted pancreaticoduodenectomy(LRPD)等,机器人在整个手术中完成的操作范围也有所不同:有的机器人下完成全部操作,有的只是完成消化道的切除或重建。两种术式胰瘘发生率、并发症发生率、手术时间、术后死亡率、再手术率、淋巴结活检数量差异无统计学意义。机器人手术组住院时间较开腹组短(P<0.00001),R0切除率高(P=0.04)。结论:与开腹手术相比,机器人胰十二指肠切除术具有微创优势。随着手术机器人的普及、技术的进步,机器人胰十二指肠切除术更多的优势会得到更好的体现。

Objective： To analyze the articles that compare robotic pancreaticoduodenectomy（ RPD） with open pancreaticoduodenectomy（ OPD）,and assess the primary and secondary outcomes between them. Methods： Pub Med,EMBASE and Cochrane Library（ till Jul. 31,2015） were searched electronically,and related references were traced. The following terms were used to perform the bibliographic research： ＂ robotic＊ ＂ or ＂robot-assisted＂and（ ＂ pancreaticoduodenectomy＂ or ＂ pancreatic surgery＂）. All the articles comparing RPD with OPD were collected. The data were analyzed by the Cochrane network Rev Man 5. 3 software. 5 articles were included in this study： 4 clinical control experiments and 1 case-matched comparison. There were 426 patients in total： 126 RPD versus 264 OPD.Results： The definitions of the robotic technique were various from each studies,such as Robot-assisted pancreaticoduodenectomy（ RAPD）,Robot-assisted laparoscopic pancreaticoduodenectomy（ RLPD）,Laparoscopic robotic-assisted pancreaticoduodenectomy（ LRPD）. Robot was completely or partially used in different studies,which meant robot finished the resection or reconstruction. The meta-analysis showed no significant differences in pancreatic fistula,morbidity,operative time,mortality,reoperation rate,or lymph nodes harvested,but RPD had less hospital stay（ P〈0. 00001） and higher R0 resection rate（ P = 0. 04）. Conclusions： RPD has many advantages than OPD as a minimally invasive procedure. With the wide usage of robot and the development of technic,RPD will show its feasibility well.