机器人辅助腹腔镜与开腹肝切除术治疗肝脏疾病效果比较的Meta分析

Clinical effect of robot-assisted laparoscopic hepatectomy versus open hepatectomy in treatment of liver diseases:A Meta-analysis

目的本研究旨在比较机器人辅助腹腔镜肝切除术(RALH)与开腹肝切除术(OH)对肝脏疾病的治疗效果与安全性。方法通过计算机全面检索Web of Science、PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献、维普和万方数据库,筛选出比较RALH与OH治疗肝脏疾病的所有中英文文献,检索时间截至2020年2月。对纳入文献进行质量学评价后,采用Revman 5.1软件进行Meta分析。结果经筛选后共纳入7篇研究,包括754例患者,其中RALH组328例,OH组426例。Meta分析结果显示,与OH组相比,RALH的手术时间较长[均值(MD)=59.41,95%可信区间(95%CI):9.74~109.08,P=0.02];且输血率[相对危险度(RR)=2.24,95%CI:1.04~4.82,P=0.04]和肝门阻断率(RR=2.27,95%CI:1.37~3.75,P=0.001)较高;但住院时间(MD=-3.87,95%CI:-5.63^-2.12,P<0.001)较短,术后总体并发症(RR=0.58,95%CI:0.41~0.81,P=0.001)及主要并发症发生率(RR=0.45,95%CI:0.22~0.91,P=0.03)均较低。而两组术中出血量比较差异无统计学意义(P>0.05)。结论在肝切除术中,RALH可以缩短住院时间并降低术后并发症,为肝脏微创切除及快速康复的实现创造了条件。

Objective To investigate the clinical effect and safety of robot-assisted laparoscopic hepatectomy(RALH)versus open hepatectomy(OH)in the treatment of liver diseases.Methods Web of Science,PubMed,Cochrane Library,Embase,CNKI,CBM,VIP,and Wanfang Data were searched for Chinese and English articles on RALH versus OH in the treatment of liver diseases published up to February 2020.The quality of the articles included was assessed,and RevMan 5.1 was used to perform the meta-analysis.Results Seven studies were included,with a total of 754 patients(328 patients in the RALH group and 426 in the OH group).The meta-analysis showed that compared with the OH group,the RALH group had a significantly longer time of operation(mean difference[MD]=59.41,95%confidence interval[CI]:9.74-109.08,P=0.02),significantly higher blood transfusion rate(relative risk[RR]=2.24,95%CI:1.04-4.82,P=0.04)and rate of hepatic portal occlusion(RR=2.27,95%CI:1.37-3.75,P=0.001),a significantly shorter length of hospital stay(MD=-3.87,95%CI:-5.63 to-2.12,P<0.001),and significantly lower overall incidence rate of postoperative complications(RR=0.58,95%CI:0.41-0.81,P=0.001)and incidence rates of major postoperative complications(RR=0.45,95%CI:0.22-0.91,P=0.03).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Conclusion For hepatectomy,RALF can shorten the length of hospital stay and reduce postoperative complications,creating conditions for minimally invasive hepatectomy and rapid recovery.