机器人辅助腹腔镜和腹腔镜下半肾切除术后安全性的meta分析

Safety of robot-assisted laparoscopic and laparoscopic heminephrectomy:a meta analysis

目的分析机器人辅助腹腔镜(RARN)与腹腔镜(LRN)下半肾切除的疗效差异。方法搜索国内外数据库中关于肾肿瘤患者行RARN或LRN下半肾切除手术的文献。按PICOS准则严格筛选参考文献,并对符合要求的文献进行数据(估计出血量、手术时间、住院时间、并发症等)提取。采用敏感性分析逐篇剔除纳入文献以证实文章结果的稳健性,并采用漏斗图及Eggers检验来探讨发表偏倚。结果有效纳入16篇文献共涉及2063例患者(RARN组1097例、LRN组966例)。RARN术相比于LRN术,术中出血量较少、住院时间较短、术后并发症发生率较低。两种术式的术中出血量和术后住院时间差异均无统计学意义(P>0.05)。RARN组术后并发症发生率少于LRN组(OR:0.643,95%CI:0.467~0.886,P=0.007)。结论RARN相比LRN下半肾切除术,患者的并发症控制良好,且在术中出血、手术时间、住院时间上的效果总体相当。

Objective To analyze the differences in efficacy of heminephrectomy with robot-assisted laparoscopy(RARN)and laparoscopic radical nephrectomy(LRN).Methods The published references in national and international databases on the comparison of clinical outcomes between heminephrectomy RARN and LRN for kidney neoplasms were searched.References were screened strictly according to PICOS criteria,and data including estimated amount of blood loss,operation time,length of hospital stay and complications were extracted from those that met the requirements.Sensitivity analysis was used to eliminate the included articles one by one to confirm the robustness of the results,and funnel plot and Eggers test were used to explore publication bias.Results A total of 16 studies involving 2063 patients(1097 in RARN group and 966 in LRN group)were included.The RARN group had less intraoperative blood loss and shorter hospital stay,but there were no significant differences between the two methods(P>0.05).The incidence of postoperative complications in RARN group was lower than that in LRN group(OR:0.643,95%CI:0.467-0.886,P=0.007).Conclusion Compared with LRN,RARN has better control of complications in the treatment of renal tumor,but the overall effects of intraoperative bleeding,operation time,and hospital stay are comparable.