机器人与腹腔镜胰十二指肠切除术近期疗效的荟萃分析

Short-term effect of robotic pancreaticoduodenectomy and laparoscopic pancreaticoduodenectomy:a meta-analysis

目的通过荟萃分析系统评价机器人胰十二指肠切除(RPD)与腹腔镜胰十二指肠切除(LPD)治疗壶腹部及其周围肿瘤的近期疗效。方法分别在Pubmed、Embase、Cochrane Library及Sinomed英文数据库中进行检索,检索词为"pancreaticoduodenectomy"、"duodenopanreatectomy"、"whipple"、"laparoscopic"、"robotic"、"Da Vinci";在万方数据知识服务平台、维普中文期刊服务平台及中国知网中文数据库中进行检索,检索词为胰十二指肠切除、腹腔镜、机器人、达芬奇,检索时限均从建库至2020年4月。分析比较RPD组与LPD组患者手术中转开腹率、术后并发症发生率以及术后住院时间等指标的差异,采用RevMan 5.3统计学软件进行荟萃分析。结果最终纳入4项回顾性队列研究共1001例患者,其中RPD组451例,LPD组550例。荟萃分析结果显示,RPD组与LPD组患者手术中转开腹率差异有统计学意义[优势比(OR)=0.35,95%CI:0.24~0.50,P<0.05]。而在术后总体并发症发生率(OR=1.23,95%CI:0.95~1.58,P>0.05)、出血发生率(OR=0.71,95%CI:0.50~1.00,P>0.05)、胰瘘发生率(OR=1.09,95%CI:0.80~1.49,P>0.05)、胃排空障碍发生率(OR=0.81,95%CI:0.57~1.14,P>0.05)以及术后住院时间(加权均数差=-2.87,95%CI:-1.44~1.70,P>0.05)方面两组进行比较,差异均无统计学意义(P>0.05)。结论RPD与LPD一样安全可行,且RPD可以降低中转开腹率、不增加手术并发症发生率。

Objective To evaluate the short-term effect of robotic pancreaticoduodenectomy(RPD)and laparoscopic pancreaticoduodenectomy(LPD)in the treatment of ampullary and periampullary tumor systematically.Methods A systematic search of the PubMed,Embase and Cochrane library database using the key words"pancreaticoduodenectomy,duodenopanreatectpmy,whipple,laparoscopic,robotic,Da Vinci".A systematic search of the Sinomed,Wangfang,VIP and CNKI databases including the key words"胰十二指肠切除","腹腔镜","机器人","达芬奇".To investigate the differences of the conversion rate of laparotomy,incidence of postoperative complications,and the postoperative hospital stay between the RPD group and the LPD group.The software RevMan5.3 was used in this meta-analysis.Results A total of 4 retrospective cohort studies and 1001 patients were included in this meta-analysis,including 451 patients in the RPD group and 550 patients in the LPD group.The results of the meta-analysis showed that there were significant differences between RPD group and LPD group for the conversion rate laparotomy(OR=0.35,95%CI:0.24-0.50,P<0.05).There were no significant differences between RPD group and LPD group for the incidence rate of overall complication(OR=1.23,95%CI:0.95-1.58,P>0.05),hemorrhage(OR=0.71,95%CI:0.50-1.00,P>0.05),pancreatic fistula(OR=1.09,95%CI:0.80-1.49,P>0.05),delayed gastric empty(OR=0.81,95%CI:0.57-1.14,P>0.05)and hospital stay after surgery(WMD=-2.87,95%CI:-1.44-1.70,P>0.05).Conclusions RPD is as safe as LPD,with the same complication rate.Therefor it is worthy for further application in medical institutions with relevant conditions.