机器人辅助与胸腔镜胸腺切除术的疗效对比:系统评价与Meta分析

Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: a systematic review and meta-analysis

目的系统评价机器人辅助下(RATS)与胸腔镜辅助下(VATS)的胸腺切除术的安全性与有效性。方法计算机检索PubMed,EMBASE,Cochrane library,CNKI,WanFang Data和CBM数据库,搜集关于RATS对比VATS的临床研究,采用RevMan 5.3进行Meta分析。结果纳入9篇病例对照研究,共纳入668名行胸腺切除术的患者。Meta分析结果显示,RATS住院天数少于VATS组[MD=-1.42, 95%CI(-2.32;-0.52),P=0.002]。术后引流天数RATS组少于VATS组[MD=-0.70,95%CI(-1.26;-0.14),P=0.01]。手术时间RATS更长[MD=13.24,95%CI(3.82; 22.66),P=0.006]。术中失血量,两组差异无统计学意义[MD=-19.22,95%CI(-52.66; 14.22),P=0.26]。中转开胸,两组差异无统计学意义[OR=0.42,95%CI(0.07; 2.35),P=0.32]。两组术后肺炎发生率差异无统计学意义[OR=0.72,95%CI(0.15; 3.42),P=0.67]。术后重症肌无力危象发生率,两组差异无统计学意义[OR=0.61,95%CI(0.17; 2.15),P=0.45]。两组术后总体并发症发生率差异无统计学意义[OR=1.4,95%CI(0.42; 4.69),P=0.59]。结论现有证据表明RATS是安全有效的,在术中失血量,中转开胸,术后肺炎并发症,术后重症肌无力发生率,术后总体并发症发生率上两种手术方式无差异,但在住院天数,术后引流天数上RATS组更有优势,手术时间RATS组更长。

Objective To systematically evaluate the safety and effectiveness of robotic-assisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)for thymectomy.Methods A computerized search was conducted in PubMed,EMBASE,Cochrane library and CBM database for clinical studies on RATS comparing VATS.RevMan 5.3 was used for meta-analysis.Results Nine case-control studies were included,including 668 patients undergoing thymectomy.Meta-analysis showed that the days of hospitalization in RATS group were less than those in VATS group(MD=-1.42,95%CI[-2.32;-0.52],P=0.002).The number of days of postoperative drainage was less than that in VATS group(MD=-0.70,95%CI[-1.26;-0.14],P=0.01).The operation time was longer in RATS(MD=13.24,95%CI[3.82;22.66],P=0.006).The intraoperative blood loss showed no statistical difference between two groups(MD=-19.22,95%CI[-52.66;14.22],P=0.26).Transthoracic thoracotomy showed no statistical difference between two groups(OR=0.42,95%CI[0.07;2.35],P=0.32).There was no statistical difference in the incidence of postoperative pneumonia between two groups(OR=0.72,95%CI[0.15;3.42],P=0.67).There was no significant difference in the incidence of myasthenia gravis crisis between two groups(OR=0.61,95%CI[0.17;2.15],P=0.45).The overall incidence of postoperative complications was not statistically different between two groups(OR=1.4,95%CI[0.42;4.69],P=0.59).Conclusion The robot-assisted thymectomy is safe and effective.There is no difference between two surgical methods:intraoperative blood loss,transthoracic thoracotomy and postoperative pneumonia complications,the incidence of myasthenia gravis crisis after surgery and overall postoperative complication rate.