机器人辅助腹腔镜对比传统腹腔镜关于全子宫切除术的Meta分析

The Comparison of Robotic-assisted VS Conventional Laparoscopes for Hysterectomy:A Meta-analysis

目的:系统评价机器人辅助腹腔镜对比传统腹腔镜关于全子宫切除术在治疗妇科良性疾病上的安全性及可行性,为临床实践提供更可靠的依据。方法:计算机检索EMBASE、Cochrane Library、各大医学杂志出版社网站及中国知网等数据库,并在PubMed、Google Scholar上追索相关文献。纳入相关随机对照试验,使用Revman5.3软件合并分析术后疗效和安全性的相关指标。结果:最终纳入5篇符合随机对照试验的文献,共494例患者:传统腹腔镜组236例,机器人辅助腹腔镜组258例。Meta分析表明:与传统腹腔镜下全子宫切除术对比,机器人辅助腹腔镜术中并发症(RR=1.45,95%CI [0.70-2.98],P=0.31)、术后并发症(RR=0.68,95%CI[0.41,1.14],P=0.14)、手术时间(WMD=20.31,95%CI [-34.35,74.96],P=0.47)、住院时间(WMD=-0.25,95%CI[-0.93,0.44],P=0.48)及中转率(RR=0.84,95%CI[0.4,3.0],P=0.79)差异均无显著性意义。结论:在妇科良性适应证中,对比传统腹腔镜全子宫切除术,机器人辅助腹腔镜不能降低术中、术后并发症率及手术中转率,也不能缩短手术时间及住院时间。在治疗妇科良性疾病中,机器人辅助腹腔镜下全子宫切除术是安全可行的,但与传统腹腔镜对比没有明显优势。

Objective:To compare the safety and efficacy of robotic-assisted laparoscopy versus conventional laparoscopy about hysterectomy in benign disease.Methods:Literature searches of electronic databases including Embase,Cochrane library,major medical magazine’s website and CNKI,were comprehensively searched,and searching the relevant literatures in Pubmed and,google scholar.Relevant outcome measures of efficacy and safety were then analyzed by using Revman5.3.Results:In all,5 RCTS with 494 patients were included in this meta-analysis.258 patients received robotic treatment,while 236 patients were treated with conventional laparoscopic approach.The meta-analysis results showed that there were no significant differences between the robotic-assisted laparoscopy and conventional laparoscopy in intraoperative complication rate(P=0.31),postoperative complication rate(P=0.14),conversion rate(P=0.79),operative time(P=0.47)and length of hospital stay(P=0.48).Conclusion:Hysterectomy for benign gynecologic conditions,compared to the conventional laparoscopy,robotic-assisted laparoscopy did not reduce complications,conversion rate,hospital stay and operative time.It was safe and feasible,but did not show a superior advantage over conventional laparoscopy.