达芬奇机器人与腹腔镜手术行右半结肠切除术安全性及有效性的Meta分析

Comparison of safety and efficacy in robotic versus laparoscopic right hemicolectomy:a meta-analysis

目的探讨达芬奇机器人与腹腔镜手术在右半结肠切除术中的安全性及有效性。方法检索Embase、Medline、Web of Science、中国知网及万方等数据库中2009年12月至今发表的有关右半结肠切除术的相关文献,使用Jadad评分及NOS评分评价文献质量,并使用Revman(5.3版)软件进行Meta分析。结果经过筛选纳入21篇文献,共计样本11648例,其中机器人组1523例,腹腔镜组10125例。Meta分析显示:在手术相关指标上,机器人组相比腹腔镜组手术时间更长[WMD=40.37,95%CI(28.88,51.86),P<0.01],但淋巴结清扫数更多[WMD=2.01,95%CI(0.59,3.44),P<0.01],中转开腹率更低[OR=0.31,95%CI(0.11,0.86),P=0.02],二者术中出血量无显著差异。在围手术期相关指标上,机器人组住院时间更短[WMD=-0.80,95%CI(-1.21,-0.39),P<0.01],肠道恢复更快[WMD=-0.43,95%CI(-0.70,-0.15),P<0.01],但费用比腹腔镜组显著提高。二者术后死亡率及并发症发生率差异无统计学意义。但机器人组伤口感染率[OR=0.66,95%CI(0.45,0.97),P=0.03]及吻合口瘘发生率[OR=0.37,95%CI(0.19,0.71),P<0.01]更低。结论达芬奇机器人行右半结肠切除术尽管手术时间较长,但术后恢复更快,淋巴清扫更彻底,伤口感染及吻合口瘘发生率更低。术后生活质量及预后资料较少,仍需开展高质量、大样本、多中心随机对照研究进行评价。

Objective To investigate safety and efficacy of Da Vinci robot and laparoscopic surgery in right hemicolectomy.Methods A systematic and electronic search of Embase,PubMed,Web of Science,Cochrane Central Register of Controlled Trials,Chinese National Knowledge Infrastructure and Wanfang Database was performed from December 2009 to present.The quality of the literature was evaluated using Jadad score and NOS score,and Review Manager 5.3 software was used to perform the meta-analysis.Results Twenty-one articles were included after screening,with a total of 11648 samples,including 1523 in the robotic group and 10125 in the laparoscopic group.Meta-analysis showed that compared with laparoscope group,robot group had more operation time[WMD=40.37,95%CI(28.88,51.86),P<0.01],more number of dissected lymph nodes[WMD=2.01,95%CI(0.59,3.44),P<0.01]and lower rate of conversion to laparotomy[OR=0.31,95%CI(0.11,0.86),P=0.02],without significant difference in intraoperative blood loss.In perioperative parameters,the robotic group had shorter hospital stay[WMD=-0.80,95%CI(-1.21,-0.39),P<0.01]and faster bowel recovery[WMD=-0.43,95%CI(-0.70,-0.15),P<0.01],but significantly higher costs than the laparoscopic group.There was no significant difference in postoperative mortality and complication rate between the two groups.However,the robotic group had lower rates of wound infection[OR=0.66,95%CI(0.45,0.97),P=0.03]and anastomotic leakage[OR=0.37,95%CI(0.19,0.71),P<0.01].Conclusion Although the operation time is longer by Da Vinci robot,the right hemicolectomy performed by Da Vinci robot has faster postoperative recovery,more thorough lymph node dissection,and lower incidence of wound infection and anastomotic leakage.However,there are few postoperative quality of life and prognostic data,and high-quality large-sample multicenter randomized controlled studies are still needed for evaluation.