机器人胃切除术与腹腔镜胃切除术治疗胃癌近期疗效的Meta分析

Short-Term Effects of Robotic Gastrectomy and Laparoscopic Gastrectomy on Gastric Cancer:A Meta-Analysis

目的从循证医学角度系统评价机器人胃切除术(RG)治疗胃癌的有效性、安全性及近期疗效。方法检索2004年7月至2015年7月发表的比较RG和腹腔镜胃切除术(LG)治疗胃癌疗效的中、英文文献,采用RevMan5.3统计软件进行Meta分析。结果共纳入22篇文献,共计7252例胃癌患者,其中RG组2111例,LG组5141例。Meta分析结果显示,与LG组比较,RG组手术时间更长(WMD=41.04,95%CI 31.68~50.39,P<0.01),术中出血量更少(WMD=-6.20,95%CI-9.65^-22.75,P<0.01),术后首次排气时间、术后首次进食时间和住院时间均明显缩短(WMD=-0.27,95%CI-0.36^-0.18;WMD=-0.24,95%CI-0.35^-0.13;WMD=-0.74,95%CI-1.11^-0.36,均P<0.05),术中淋巴结清扫数目更多(WMD=1.89,95%CI 1.28~2.49,P<0.05)。RG组近、远端切缘距离和术后总并发症发生率与LG组比较差异均无统计学意义(WMD=0.10,95%CI-0.03^-0.24;WMD=0.22,95%CI-0.28^-0.71;WMD=0.96,95%CI 0.81~1.15,均P>0.05)。结论RG治疗胃癌有效且安全,具有良好的近期疗效。

ObjectiveTo systematically evaluate the efficacy,safety and short-term effect of robotic gastrectomy(RG)in the treatment of gastric carcinoma from the point of view of evidence-based medicine.MethodsThe English and Chinese literature published between July2004and July2015about the comparison of RG and laparoscopic gastrectomy(LG)for gastric carcinoma were searched,and the meta-analysis was conducted with Review Manager5.3software.ResultsTotally7252gastric cancer patients in22studies were involved,including2111cases in RG group and5141cases in LG group.Meta-analysis results showed that RG was associated with longer operative time(WMD=41.04,95%CI31.68-50.39,P<0.01),less intraoperative blood loss(WMD=-36.20,95%CI-9.65--22.75,P<0.01),shorter time to first flatus(WMD=-0.27,95%CI-0.36--0.18,P<0.05)and first eating(WMD=-0.24,95%CI-0.35--0.13,P<0.05)and length of hospital stay(WMD=-0.74,95%CI-1.11--0.36,P<0.05),and higher number of lymph nodes dissected(WMD=1.89,95%CI1.28-2.49,P<0.05)than LG group.There were no significant differences in the length of proximal and distal resection margin and the incidence of postoperative complications between the two groups(WMD=0.10,95%CI-0.03-0.24;WMD=0.22,95%CI-0.28--0.71;WMD=0.96,95%CI0.81-1.15;respectively)(P>0.05).ConclusionRG is a safe and feasible for gastric cancer and has a good short-term effect.