机器人辅助与传统腹腔镜胆囊切除术治疗良性胆囊疾病疗效比较的Meta分析

Meta-analysis of robotic-assisted versus conventional laparoscopic cholecystectomy for benign gallbladder diseases

目的:比较机器人辅助腹腔镜胆囊切除术(RAC)与传统腹腔镜胆囊切除术(TLC)治疗良性胆囊疾病的疗效。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Rev Man5.3软件进行Meta分析。结果:纳入26篇文献,共4004例患者,其中1833例行RAC,2171例行TLC。Meta分析结果显示,与TLC比较,RAC的手术时间延长(MD=13.14,95%CI=4.79~21.50,P=0.002)、切口疝发生率升高(RR=3.59,95%CI=1.77~7.28,P=0.0004)、术中中转开腹率降低(RR=0.60,95%CI=0.40~0.92,P=0.02)。而在术中并发症、术后并发症、30d再入院率、住院时间、失血量等方面,两者之间均无统计学差异(均P>0.05)。结论:当前的证据表明,RAC具有与TLC相似的安全性和有效性但并不比TLC有优势。

Objective： To compare the clinical efficacy of robotic-assisted cholecystectomy（RAC） and traditional laparoscopic cholecystectomy（TLC） in treatment of benign gallbladder diseases.Methods： After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria. After data extraction, Meta-analysis was performed by using RevM an 5.3 software. Results： Twenty-six studies were finally included, involving 4 004 patients, of whom, 1 833 cases underwent RAC and 2 171 cases underwent TLC. The results of Meta-analysis showed that RAC had prolonged operative time（MD=13.14, 95% CI=4.79–21.50, P=0.002） and increased incidence of incisional hernia（RR=3.59, 95% CI=1.77–7.28, P=0.0004）, but reduced intraoperative conversion rate（RR=0.60, 95% CI=0.40–0.92, P=0.02） compared with TLC. However, no significant differences were found in intraoperative complications, postoperative complications, 30 d readmission rate, length of hospital stay and blood loss between the two procedures（all P〉0.05）. Conclusion： Current evidence suggests that RAC has similar safety and effectiveness as TLC, but no advantage over TLC.