机器人与腹腔镜脾切除术治疗非创伤性脾脏疾病效果比较的Meta分析

Clinical effect of robotic versus laparoscopic splenectomy in treatment of nontraumatic splenic diseases:A Meta-analysis

目的比较机器人脾切除术和腹腔镜脾切除术对非创伤性脾脏疾病治疗的有效性和安全性。方法系统检索Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数库,根据纳入及排除标准选择比较机器人脾切除术与腹腔镜脾切除术治疗非创伤性脾脏疾病的所有中英文文献,检索时间截止到2019年3月。对纳入文献进行质量学评价后,采用Cochrane library提供的软件RevMan5.0进行分析。对研究中的连续性变量及二分类变量分别采用均数差(MD)及率差(RD)为效应指标,计算其合并值及95%可信区间(95%CI)。结果经筛选后共纳入7篇研究,包括374例患者,其中机器人脾切除组160例,腹腔镜脾切除组214例。Meta分析结果显示,与腹腔镜脾切除术相比,机器人脾切除术的术中失血量(MD=-127.14,95%CI:-199.87^-54.42,P<0.001)、中转开腹率(RD=-0.06;95%CI:-0.11^-0.01,P=0.02]及术后并发症(RD=-0.10,95%CI:-0.20^-0.01,P=0.04]均显著降低。然而在手术时间和住院时间方面二者差异均无统计学意义(P值均>0.05)。结论基于目前的证据,在非创伤性脾脏疾病手术中,机器人脾切除术的有效性和安全性部分优于腹腔镜,未来还需要多中心大样本随机对照试验来予以验证。

Objective To investigate the clinical effect and safety of robotic versus laparoscopic splenectomy in the treatment of nontraumatic splenic diseases.Methods According to the inclusion and exclusion criteria,PubMed,Web of Science,Embase,Cochrane Library,CBM,CNKI,Wanfang Data,and VIP were systematically searched for Chinese and English articles on the comparison of robotic splenectomy and laparoscopic splenectomy in the treatment of nontraumatic splenic diseases published up to March 2019.After quality assessment was performed for the articles included,RevMan 5.0 provided by Cochrane Library was used for analysis.Mean difference (MD) and rate difference (RD) were used as the effect indicators for continuous variables and binary variables,and pooled value and 95% confidence interval (CI) were calculated.Results A total of 7 studies with 374 patients were included,with 160 patients in the robotic splenectomy group and 214 in the laparoscopic splenectomy group.The results of the meta-analysis showed that compared with laparoscopic splenectomy,robotic splenectomy had significantly lower intraoperative blood loss (MD=-127.14,95%CI:-199.87 to 54.42,P <0.01),rate of conversion to laparotomy (RD=-0.06,95%CI:-0.11 to 0.01,P =0.02),and rate of postoperative complications (RD=-0.10,95%CI:-0.20 to 0.01,P =0.04).There were no significant differences in time of operation and length of hospital stay between the two surgical procedures (both P >0.05).Conclusion Based on current evidence,robotic splenectomy has better clinical effect and safety than laparoscopic splenectomy in some aspects in the treatment of nontraumatic splenic diseases,and more multicenter large-sample randomized controlled trials are needed in the future for verification.