机器人辅助与腹腔镜结直肠癌手术疗效比较的Meta分析

Robotic-assisted versus laparoscopic colorectal cancer resection:a Meta-analysis

目的：比较机器人辅助结直肠癌手术（RCS）与腹腔镜结直肠癌手术（LCS）的临床疗效。方法：系统检索文献数据库，按照纳入、排除标准筛选符合标准的文献，用ReviewManager5．2进行Meta分析。结果：共纳入9篇文献，包括2项随机对照研究，7项高质量病例对照研究，共879例患者，其中RCS组416例，LCS组463例。Meta分析结果显示，与LCS组比较，RCS组手术时间延长（WMD=65．06，95％CI=37．14-92．99），但在术中出血量（WMD=-11．55，95％CI=-32．31-9．21）、术后24h疼痛评分（WMD=-0．08，95％CI=-0．55-0．39）、术后排气时间（WMD=-0．04，95％CI=-0．21-0．13）、术后进食时间（WMD=-0．08，95％CI=-0．41-0．25）、住院时间（WMD=-0．67，95％CI=-1．50-0．17）、术中转开腹率（OR=0．60，95％CI=0．21-1．75）及并发症发生率（OR=1．04，95％CI=0．67-1．60）方面均无统计学差异（均P〉0．05）。结论：RCS提供与LCS相当的安全性和有效性，且具有更清晰、更立体的手术视野，操作灵活，能够明显减轻外科医师生理疲劳，值得临床应用。

Objective： To compare the clinical efficacy of robotic-assisted colorectal surgery （RCS） and laparoscopic colorectal surgery （LCS）. Methods： After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria, and then Meta-analysis was performed by using Review Manager 5.2. Results： A total of 9 studies involving 879 patients were finally included, with 416 cases in RCS group and 463 cases in LCS group. Results of Meta-analysis showed that in RCS group compared with LCS group, the operative time （WMD=65.06, 95% CI=37.14-92.99） was significantly prolonged, but no significant difference was noted in terms of intraoperative blood loss （WMD=-11.55, 95% CI=-32.31-9.21）, pain score at postoperative 24 h（WMD=-0.08, 95% CI=-0.55-0.39）, time to first flatus （WMD=-0.04, 95% CI=-0.21-0.13）, time to first food intake （WMD=-0.08, 95% CI=-0.41-0.25）, length of hospitalization （WMD=-0.67, 95% CI=-1.50-0.17）, conversion rate （OR=0.60, 95% CI=0.21-1.75） and incidence of complications （OR=1.04, 95% CI=0.67-1.60） （all P〉0.05）. Conclusion： RCS has similar safety and effectiveness as LCS, and has advantages of clearer and greater stereo operation field, better operational flexibility and alleviating surgeons＇ physiological fatigue. So it deserves to be used in clinical practice.