机器人辅助与视频辅助微创食管癌根治术的系统回顾和荟萃分析

Meta-Analysis of Robot-assisted Minimally Invasive Esophagectomy and Video-assisted Minimally Invasive Esophagectomy

目的探讨机器人辅助(RAMIE)与视频辅助微创食管癌根治术(VAMIE)的安全性及近期效果。方法从建库到2022年2月1日,对PubMed、Cochrane、Embase、万方和中国知网(CNKI)这5个大型数据库进行了系统检索。检索到的文献由2位独立的研究者根据纳入、排除标准进行筛选整理后,共筛选出13篇合格文献,这项荟萃分析纳入了随机对照试验(RCTs)和回顾性队列研究(RCSs),通过观察术后吻合口瘘、术后乳糜漏、术后肺炎、术后30 d死亡人数,比较了RAMIE和VAMIE的短期临床结果,采用Review Manager 5.4软件进行统计分析。结果经过筛选,最后有13篇文章,共计4631例患者被纳入,包括RAMIE组2321例患者和VAMIE组2310例患者。RAMIE组的术后30 d死亡率低于VAMIE组(OR=0.69,95%CI:0.50~0.96,P=0.03)。与VAMIE组相比,RAMIE组的术后肺炎发病率显著降低(OR=0.72,95%CI:0.55~0.95,P=0.02)。结论RAMIE组与VAMIE组的短期术后效果相似,但在术后肺炎发生率及术后30 d死亡率方面体现出优势。

Objective To explore the safety and short-term effects of robot-assisted minimally invasive esophagectomy(RAMIE)compared with video-assisted minimally invasive esophagectomy(VAMIE).Methods A systematic search was conducted on 5 large databases(PubMed,Cochrane,Embase,Wanfang and CNKI)from the establishment of the database to February 1,2022.The retrieved literatures were screened by 2 independent investigators according to the inclusion and exclusion criteria.This meta-analysis included randomized controlled trials(RCTs)and retrospective cohort studies(RCSs).By observing the postoperative anastomotic leakage,postoperative chylous leakage,postoperative pneumonia,the number of deaths 30 days after operation,the short-term clinical results of RAMIE and VAMIE were compared;the software Review Manager 5.4 was used for statistical analysis.Results 4631 patients in 13 papers were enrolled,including 2321 in the RAMIE group and 2310 in the VAMIE group.The 30-day postoperative mortality in the RAMIE group was lower than that in the VAMIE group(OR=0.69,95%CI:0.50~0.96,P=0.03).Compared with VAMIE group,the incidence rate of postoperative pneumonia in RAMIE group was significantly lower(OR=0.72,95%CI:0.55~0.95,P=0.02).Conclusion The short-term postoperative effects of RAMIE group and VAMIE group were similar,but there was an advantage in the incidence of postoperative pneumonia and 30-day mortality in the RAMIE group.