机器人辅助腹腔镜与传统腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻的Meta分析

Robotic-assisted laparoscopic pyeloplasty versus laparoscopic pyeloplasty for children with ureteropelvic junction obstruction:Meta-analysis of comparative studies

目的运用Meta分析评价传统腹腔镜下肾盂成形术与机器人辅助腹腔镜肾盂成形术治疗儿童肾盂输尿管连接处梗阻的临床效果。方法计算机检索PubMed、Cochrane database、Web of Science等英文数据库及中国知网、维普数据库、万方数据库等中文数据库相关文献,文献公开发表时间截至2020年10月。采用RevMan5.3对文献数据进行Meta分析。二分类变量采用OR作为分析统计量;对连续型变量,采用加权均数差(mean difference,MD)作为分析统计量。对于纳入文献较少、数据不够全面的研究指标采取描述性分析。结果最终共纳入12篇文献,有效病例数1531例,均行肾盂成形术。机器人辅助腹腔镜手术在以下方面优于传统腹腔镜手术:手术成功率[OR=2.66,95%CI(1.09,6.49)]、手术时间[MD=-6.68,95%CI(-13.10,-0.26)]、术后住院时间[MD=-0.91,95%CI(-1.01,-0.81)]、术后并发症发生率[OR=0.49,95%CI(0.27,0.80)]、术后随访时间[MD=-3.14,95%CI(-4.37,-1.91)]、再手术率[OR=0.27,95%CI(0.08,0.90)],上述指标的组间差异均有统计学意义(P<0.05)。在描述性分析中,机器人辅助腹腔镜手术后镇痛药的使用率较低,但住院费用较高。结论与传统腹腔镜肾盂成形术相比,机器人辅助腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻成功率更高,术后并发症及术后镇痛药的使用更少,手术时间和术后住院时间较短,患儿术后住院及随访期间因各种原因导致再次手术的发生率更低,但费用较高,在小年龄婴幼儿患者中的应用存在一定的局限性。

Objective To systematiclly review the efficacy of robotic-assisted laparoscopic pyeloplasty(RALP)versus laparoscopic pyeloplasty(LP)for children with ureteropelvic junction obstruction(UPJO).Methods A literature search was performed within the databases of PubMed,Cochrane,Web of Science and China National Knowledge Infrastructure(CNKI),VIP and WanFang from the inceptions up to October 2020.Meta-analysis was performed by RevMan 5.3.Results A total of 12 articles involving 1531 patients were retrieved.RALP was superior in the following aspects with significant differences:operative success rate[OR=2.66,95%CI(1.09,6.49)],operative duration[MD=-6.68,95%CI(-13.10,-0.26)],postoperative length of stay[MD=-0.91,95%CI(-1.01,-0.81)]and postoperative complications[OR=0.49,95%CI(0.27,0.80)].In descriptive analysis,dosing of analgesic was less in RALP group than that in LP group and the expenditure was higher in RALP group than LP group.Conclusion As compared with LP,RALP has higher success rate and fewer postoperative complications for UPJO.Operative duration and postoperative length of stay were shorter in the RALP group.However,the expenditure was higher.