机器人与腹腔镜胃癌手术临床疗效对比的Meta分析

Robotic versus laparoscopic gastrectomy for gastric cancer： a meta-analysis

目的比较机器人与腹腔镜胃癌手术的临床疗效。方法计算机检索2015年7月以来．在万方数据库、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、Pubmed、Embase、CochraneLibrary及WebofScience等数据库公开发表的比较胃癌机器人手术与腹腔镜手术临床疗效的研究，采用Statal2．0统计软件进行Meta分析，应用加权平均值差（WMD）以及优势比（OR）来比较两组患者术中及术后情况。结果共纳入16篇文献的5764例胃癌患者，其中机器人组1593例，腹腔镜组4171例。Meta分析结果显示，机器人组手术时间更长[WMD（95％CI）：49．68（35．54。63．82），P=0．000]，但术中失血量更少[WMD（95％CI）：-26．10（-42．90--9．31），P=0．002]，术后住院时间更短[WMD（95％CI）：-0．72（-1．35—-0．09），P=0．024]。两组胃癌手术的中转率、围手术期病死率、术后并发症发生率、近端和远端切缘以及淋巴结清扫数目的差异无统计学意义（均P〉0．05）。在远端胃癌切除术和早期胃癌的Meta分析结果中，机器人手术清扫淋巴结数目比腹腔镜手术多[远端胃癌：WMD（95％CI）：2．23（O．33-4．13），P=0．021；早期胃癌：WMD（95％CI）：2．58（1．05～4．12），P=0．001]。结论与腹腔镜手术相比，机器人手术同样能够达到胃癌根治性切除．且具有术中失血量少，清扫淋巴结数目多等优势。

Objective To compare the clinical efficacy with meta-analysis between robot- assisted gastrectomy （RAG） and laparoscopy-assisted gastrectomy （LAG） for gastric cancer. Methods A literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, CNKI （Chinese National Knowledge Infrastructure）, and CBM （China Biological Medicine） databases for clinical researches published before July 2015 that compared RAG with LAG. Operative time, estimated blood loss, harvested lymph nodes, proximal margin, distal margin, hospital stay, conversion and complications were compared using weighted mean differences （WMD） and odds ratios （OR）. Results Sixteen studies were included in the analysis, comprising 5 764 patients（1 593 RAGs, 4 171 LAGs）. RAG was associated with longer operative time （WMD = 49.68, 95% C1：35.54 to 63.82, P = 0.000）, less estimated blood loss （WMD = -26.10, 95% CI： -42.90 to -9.31,P= 0.002）, and shorter hospital stay （WMD = -0.72,95% CI： - 1.35 to -0.09, P = 0.024）. Conversion, mortality, complications, proximal margin, distal margin and harvested lymph nodes of RAG were similar to LAG. In meta-analysis results of distal gastrectomy and early-stage gastric cancer, RAG had more harvested lymph nodes （distal gastrectomy： WMD = 2.23, 95% CI： 0.33 to 4.13, P=0.021; early-stage gastric cancer： WMD = 2.58, 95% CI： 1.05 to 4.12, P=0.001）. Conclusions RAG can be performed safely with less estimated blood loss and more harvested lymph nodes as compared to LAG. Radicalresection can be achieved by RAG.