达芬奇机器人与传统腹腔镜胰十二指肠切除术近期疗效及安全性比较的Meta分析

Short-term efficacy and safety of Da Vinci robotic pancreaticoduodenectomy versus traditional laparoscopic pancreaticoduodenectomy:A meta-analysis

目的本研究旨在系统评价机器人手术系统与传统腹腔镜手术在胰十二指肠切除术中应用的近期疗效与安全性,为临床研究与实践提供参考。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普等中英文期刊服务平台,纳入所有对比机器人辅助腹腔镜和传统腹腔镜应用于胰十二指肠切除术临床疗效的队列研究。按照Cochrane系统评价纳入文献的质量,使用Stata 15.1软件对提取的相关结局指标进行Meta分析。结果最终纳入12篇合格的队列研究,共计1630例患者,RPD(机器人胰十二指肠切除术)组患者683例,LPD(腹腔镜胰十二指肠切除术)组患者947例。Meta分析结果显示:RPD组与LPD组患者术后出血率(OR=0.66,95%CI:0.48~0.91)、中转开腹率(OR=0.41,95%CI:0.30~0.56)、预估手术出血量(WMD=-0.77,95%CI:-1.33~-0.22)、术后住院时间(WMD=-0.45,95%CI:-0.80~-0.11)比较,差异均具有统计学意义(P值均<0.05)。发表国家这一因素可能是术后总体并发症发生率亚组间异质性的来源之一(P<0.05)。结论达芬奇机器人手术系统相较于传统LPD,可降低术后出血率、术中出血量、中转开腹率,缩短术后住院时间,且不增加手术时间和术后总体并发症发生率,两种手术方式均同样安全可行。

Objective To systematically evaluate the short-term efficacy and safety of robotic pancreaticoduodenectomy(RPD)versus traditional laparoscopic pancreaticoduodenectomy(LPD),and to provide a reference for clinical research and practice.Methods Chinese and English databases such as PubMed,Embase,the Cochrane Library,CNKI,Wanfang Data,and VIP were searched to include the cohort studies comparing the clinical efficacy of robot-assisted laparoscopy and traditional laparoscopy in pancreaticoduodenectomy.The quality of included articles was evaluated based on Cochrane systematic review,and Stata15.1 software was used to perform a meta-analysis of related outcome measures extracted.Results A total of 12 cohort studies were included,with 1630 patients in total,and there were 683 patients in the RPD group and 947 patients in the LPD group.The meta-analysis showed that there were significant differences between the RPD group and the LPD group in postoperative bleeding rate(odds ratio[OR]=0.66,95%confidence interval[CI]:0.48-0.91,P<0.05),rate of conversion to laparotomy(OR=0.41,95%CI:0.30-0.56,P<0.05),estimated intraoperative blood loss(weighted mean difference[WMD]=-0.77,95%CI:-1.33 to-0.22,P<0.05),and length of postoperative hospital stay(WMD=-0.45,95%CI:-0.80 to-0.11,P<0.05).Country of publication might be one of the sources of heterogeneity in the incidence rate of postoperative complications between subgroups(P<0.05).Conclusion Compared with traditional LPD,da Vinci RPD can reduce postoperative bleeding rate,intraoperative blood loss and rate of conversion to laparotomy and shorten postoperative hospital stay,and meanwhile,it does not increase the operation time and the incidence rate of postoperative complications.Both surgical procedures are safe and feasible.