机器人与腹腔镜肝切除术近期疗效的Meta分析

Short-term efficacy of robotic hepatectomy and laparoscopic hepatectomy:a meta-analysis

目的:通过Meta分析系统评价机器人肝切除术(RH)与腹腔镜肝切除术(LH)治疗肝脏良恶性病变的近期疗效。方法:系统性检索万方数据库、维普、中国知网、PubMed、Embase、Cochrane Library中相关文献。检索时间为建库至2022年7月。中文检索词为“机器人”“腹腔镜”“肝切除术”,英文检索词为“robotic”“laparoscope”“hepatectomy”“liver resection”。比较RH组与LH组手术时间、中转开腹率、术中出血量、输血率、R0切除率、最大肿瘤长径、住院时间、术后并发症等指标。采用Review Manager 5.3软件进行Meta分析。结果:最终纳入34篇文献、5299例患者,其中RH组1806例,LH组3493例。结果显示,与LH组相比,RH组手术时间较长(MD=33.22,95%CI:19.70~46.74,P<0.001),最大肿瘤长径(MD=0.34,95%CI:0.16~0.52,P<0.001)较大,而中转开腹率(OR=0.42,95%CI:0.33~0.55,P<0.001)、总并发症发生率(OR=0.81,95%CI:0.69~0.95,P=0.008)较低,差异有统计学意义(P<0.05)。两组术中出血量、R0切除率、恶性肿瘤占比、住院时间差异无统计学意义(P>0.05)。结论:RH与LH均安全、可行,RH在中转开腹率、并发症发生率及较大肿瘤切除等方面具有优势。

Objective:To systematically evaluate the short-term efficacy of robotic hepatectomy(RH)and laparoscopic hepatectomy(LH)in the treatment of benign and malignant liver lesions by meta-analysis.Methods:A systematic search was conducted for relevant literatures in Wanfang Database,VIP,CNKI,PubMed,Embase and Cochrane Library.The retrieval time was from the establishment of the database to Jul.2022.The Chinese key words were"robotic","laparoscope"and"hepatectomy".The English search terms were"robotic","laparoscope","hepatectomy"and"liver resection".The operation time,incidence of conversion to open surgery,intraoperative bleeding,blood transfusion rate,R0 resection rate,maximum tumor length,hospital stay,postoperative complications and other indicators of patients in RH group and LH group were compared.The review manager 5.3 software was used for metaanalysis.Results:Finally,34 literatures were included in the systematic evaluation,with a total of 5299 patients,including 1806 in RH group and 3493 in LH group.The results of meta-analysis showed that compared with LH group,the operation time(MD=33.22,95%CI:19.70~46.74,P<0.001)and the maximum tumor length(MD=0.34,95%CI:0.16~0.52,P<0.001)of RH group were longer,while the conversion to laparotomy rate(OR=0.42,95%CI:0.33~0.55,P<0.001)and total complications incidence(OR=0.81,95%CI:0.69~0.95,P=0.008)of RH group were less,and the differences were statistically significant(P<0.05).There was no significant difference in intraoperative bleeding,R0 resection rate,malignant tumor rate and hospital stay between the two groups(P>0.05).Conclusions:RH and LH are both safe and feasible,and RH has advantages in conversion to laparotomy,complication rate and large tumor resection.