机器人与腹腔镜左半结肠切除术对比的Meta分析

Meta-analysis of robotic versus laparoscopic left hemicolectomy

目的通过Meta分析的方法比较腹腔镜左半结肠切除术与机器人辅助左半结肠切除术之间的短期疗效、安全性与可行性。方法检索Pubmed,Embase,Web of science,万方,维普,中国生物医学文献数据库(CBM),中国知网(CNKI)数据库中有关腹腔镜与机器人行左半结肠切除术对比的相关文献。检索时间为从建库至2019年8月。并用NOS评分评价文献质量,用Review Manager5.3软件进行统计分析。结果共纳入文献12篇,共包括4633例患者。其中腹腔镜组(LA)患者2409例,机器人组(RA)患者2224例。分析研究结果显示,相比于RA组,LA组中出血量较多(MD=11.07,95%CI=3.65~18.5;P=0.003<0.05),中转开腹率高(OR=1.74,95%CI=1.40~2.16;P<0.001),术后并发症偏多(OR=1.30,95%CI=1.00~1.69;P=0.05),且住院时间较长(MD=0.74,95%CI=0.19~1.30;P=0.008<0.05)。但LA组手术时间短(MD=-55.06,95%CI=-69.84~40.28;P<0.001),手术总费用少(MD=-2435.43,95%CI=-3575.16^-1295.70;P<0.001)。其余对比则差异无统计学意义。且各亚组对比与整体对比一致。结论机器人辅助左半结肠切除术在短期疗效及安全性都有所保障,但是由于临床医生对其操作的不熟练及其昂贵的价格,加上目前研究均为短期研究,其是否能完全替代腹腔镜手术仍需要长期观察。

Objective In this study,we compared short-term efficacy,safety and feasibility between laparoscopic left hemicolectomy and robotic-assisted left colectomy using Meta-analysis.Methods We conducted a systemic literature review on laparoscopic versus robotic-assisted left hemicolectomy by searching the Pubmed,Embase,Web of Science,Wanfang,Weipu,CBM,CNKI and other databases,dated from the establishment of the database to August 2019.The quality of the literature was evaluated by NOS score,and statistical analysis was performed using ReviewManager 5.3 software.Results A total of 12 articles were included in this study with a total of 4633 patients.There were 2409 patients in the laparoscopic group and 2224 patients in the robotic-assisted group.The Meta-analysis showed that compare to the robotic-assisted group,the laparoscopic group had higher amount of blood loss(MD=11.07,95%CI=3.65~18.5;P=0.003<0.05),higher rate of conversion to open(OR=1.74,95%CI=1.40~2.16;P<0.001),more postoperative complications(OR=1.30,95%CI=1.00~1.69;P=0.05),and longer hospital stay(MD=0.74,95%CI=0.19~1.30;P=0.008<0.05).However,the laparoscopic procedures had significant advantages with shorter operation time(MD=-55.06,95%CI=-69.84^-40.28;P<0.001),and lower costs(MD=-2435.43,95%CI=-3575.16^-1295.70;P<0.001).There was no statistically significant difference in the others between the two groups.The comparison of each subgroup was consistent with that of the whole group.Conclusion Robotic-assisted left hemicolectomy was favorable regarding both short-term efficacy and safety,but because of the steep learning curve of this technique and the high costs of the procedures,whether this procedure can completely replace laparoscopic surgery remains unclear due to the relative novelty of these surgical approaches.