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中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (02) : 178 -187. doi: 10.3877/cma.j.issn.2095-3224.2020.02.013

所属专题: 机器人手术 文献

论著

机器人与腹腔镜左半结肠切除术对比的Meta分析
厉泽宇1, 彭杨杰1, 王晶1, 卢敏1,()   
  1. 1. 110000 沈阳,中国医科大学附属第一医院肛肠外科
  • 收稿日期:2019-09-09 出版日期:2020-04-25
  • 通信作者: 卢敏

Meta-analysis of robotic versus laparoscopic left hemicolectomy

Zeyu Li1, Yangjie Peng1, Jing Wang1, Min Lu1,()   

  1. 1. Department of Anus & Intestine Surgery, The First Hospital of China Medical University, Shenyang 110000, China
  • Received:2019-09-09 Published:2020-04-25
  • Corresponding author: Min Lu
  • About author:
    Corresponding author: Lu Min, Email:
引用本文:

厉泽宇, 彭杨杰, 王晶, 卢敏. 机器人与腹腔镜左半结肠切除术对比的Meta分析[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(02): 178-187.

Zeyu Li, Yangjie Peng, Jing Wang, Min Lu. Meta-analysis of robotic versus laparoscopic left hemicolectomy[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(02): 178-187.

目的

通过Meta分析的方法比较腹腔镜左半结肠切除术与机器人辅助左半结肠切除术之间的短期疗效、安全性与可行性。

方法

检索Pubmed,Embase,Web of science,万方,维普,中国生物医学文献数据库(CBM),中国知网(CNKI)数据库中有关腹腔镜与机器人行左半结肠切除术对比的相关文献。检索时间为从建库至2019年8月。并用NOS评分评价文献质量,用Review Manager5.3软件进行统计分析。

结果

共纳入文献12篇,共包括4 633例患者。其中腹腔镜组(LA)患者2 409例,机器人组(RA)患者2 224例。分析研究结果显示,相比于RA组,LA组中出血量较多(MD=11.07,95%CI=3.65~18.5;P=0.003<0.05),中转开腹率高(OR=1.74,95%CI=1.40~2.16;P<0.001),术后并发症偏多(OR=1.30,95%CI=1.00~1.69;P=0.05),且住院时间较长(MD=0.74,95%CI=0.19~1.30;P=0.008<0.05)。但LA组手术时间短(MD=-55.06,95%CI=-69.84~40.28;P<0.001),手术总费用少(MD=-2 435.43,95%CI=-3 575.16~-1 295.70;P<0.001)。其余对比则差异无统计学意义。且各亚组对比与整体对比一致。

结论

机器人辅助左半结肠切除术在短期疗效及安全性都有所保障,但是由于临床医生对其操作的不熟练及其昂贵的价格,加上目前研究均为短期研究,其是否能完全替代腹腔镜手术仍需要长期观察。

Objective

In this study, we compared short-term efficacy, safety and feasibility between laparoscopic left hemicolectomy and robotic-assisted left colectomy using Meta-analysis.

Methods

We conducted a systemic literature review on laparoscopic versus robotic-assisted left hemicolectomy by searching the Pubmed, Embase, Web of Science, Wanfang, Weipu, CBM, CNKI and other databases, dated from the establishment of the database to August 2019. The quality of the literature was evaluated by NOS score, and statistical analysis was performed using ReviewManager 5.3 software.

Results

A total of 12 articles were included in this study with a total of 4 633 patients. There were 2 409 patients in the laparoscopic group and 2 224 patients in the robotic-assisted group. The Meta-analysis showed that compare to the robotic-assisted group, the laparoscopic group had higher amount of blood loss (MD=11.07, 95%CI=3.65~18.5; P=0.003<0.05), higher rate of conversion to open (OR=1.74, 95%CI=1.40~2.16; P<0.001), more postoperative complications (OR=1.30, 95%CI=1.00~1.69; P=0.05), and longer hospital stay (MD=0.74, 95%CI=0.19~1.30; P=0.008<0.05). However, the laparoscopic procedures had significant advantages with shorter operation time (MD=-55.06, 95%CI=-69.84~-40.28; P<0.001), and lower costs (MD=-2 435.43, 95%CI=-3 575.16~-1 295.70; P<0.001). There was no statistically significant difference in the others between the two groups. The comparison of each subgroup was consistent with that of the whole group.

Conclusion

Robotic-assisted left hemicolectomy was favorable regarding both short-term efficacy and safety, but because of the steep learning curve of this technique and the high costs of the procedures, whether this procedure can completely replace laparoscopic surgery remains unclear due to the relative novelty of these surgical approaches.

图1 文献检索流程图
表1 纳入患者基本信息(±s,例)
纳入研究 样本数 性别(男/女) 年龄(岁) BMI(kg/m2 死亡数
LA RA LA RA LA RA LA RA LA RA
王巍201110 2 2 0/2 1/1 64±8 67±7 25.5±0.5 23±1 ? ?
Guido Woeste 20058 23 4 ? ? ? ? ? ? ? ?
Mark A. Casillas 201311 82 68 37/45 38/30 60±13 56±12 28.4±5.3 28.3±5.4 0 0
Amir L. Bastawrous 201917 1 236 1 236 546/690 557/679 ? ? ? ? ? ?
Hiroyuki Sawada 201514 20 10 11/9 6/4 64.0±7.8 64.5±5.0 24.1±3.7 22.0±3.1 ? ?
Jin Cheon Kim 201815 51 20 33/18 12/8 56±13 58±10 24±3.0 25.5±3.8 0 0
Dae Ro Lim 201312 146 34 87/59 21/11 59.7±11.5 59.6±8.4 23.8±3.8 24.8 ±2.1 ? ?
Mohammed H. Al-Temimi 201916 439 439 197/242 195/244 57.0±11.8 56.8±11.6 29.5±6.0 29.3±6.0 1 1
Ogilvie JW 201918 69 69 28/41 25/44 57.9±12.6 56.9±12.3 29.5±5.5 30.1±6.6 ? ?
Conor P. Delaney 20037 3 3 1/2 1/2 46.3±2.5 45.8±2.3 27.3±2.6 33.3±6.7 ? ?
A. L. Rawlings 20079 12 13 6/6 6/7 60.3±11.8 61.2±16.2 27.8±6.0 27.8±4.6 ? ?
Bradley R. Davis 201413 326 326 ? ? ? ? ? ? ? ?
纳入研究 患病类型(良性/恶性) ASA评分 TNM分期 研究类型 NOS评分
LA RA LA RA
LA RA Ⅰ&Ⅱ ≥Ⅲ Ⅰ&Ⅱ ≥Ⅲ ≥Ⅲ ≥Ⅲ
王巍201110 0/2 0/2 1 1 2 0 0 1 1 1 1 0 病例对照 6
Guido Woeste 20058 23/0 4/0 ? ? ? ? ? ? ? ? ? ? 病例对照 6
Mark A. Casillas 201311 53/29 47/21 64 18 56 12 ? ? ? ? ? ? 病例对照 6
Amir L. Bastawrous 201917 1 236/0 1 236/0 ? ? ? ? ? ? ? ? ? ? 病例对照 7
Hiroyuki Sawada 201514 0/20 0/10 18 2 10 0 12 4 4 5 3 2 病例对照 6
Jin Cheon Kim 201815 0/51 0/20 48 3 20 0 16 16 19 3 12 4 病例对照 7
Dae Ro Lim 201312 0/146 0/34 140 6 32 2 52 36 58 14 12 8 病例对照 7
Mohammed H. Al-Temimi 201916 439/0 439/0 301 138 293 146 ? ? ? ? ? ? 病例对照 8
Ogilvie JW 201918 69/0 69/0 ? ? ? ? ? ? ? ? ? ? 病例对照 7
Conor P. Delaney 20037 3/0 2/1 2 1 2 1 ? ? ? ? ? ? 病例对照 6
A. L. Rawlings 20079 10/2 10/3 ? ? ? ? ? ? ? ? ? ? 病例对照 6
Bradley R. Davis 201413 ? ? ? ? ? ? ? ? ? ? ? ? 病例对照 7
纳入研究 手术部位(LA/RA)
横结肠左曲 脾曲 降结肠 乙状结肠 DK
王巍201110 ? 1/0 0/1 1/1 ?
Guido Woeste 20058 ? ? ? 23/4 ?
Mark A. Casillas 201311 2/4 2/2 1/0 24/15 53/47
Amir L. Bastawrous 201917 ? ? ? 1 236/1 236 ?
Hiroyuki Sawada 201514 ? ? ? 8/3 12/7
Jin Cheon Kim 201815 ? 22/5 21/14 ? 8/1
Dae Ro Lim 201312 ? ? ? 146/34 ?
Mohammed H. Al-Temimi 201916 ? ? ? ? 439/439
Ogilvie JW 201918 ? ? ? 69/69 ?
Conor P. Delaney 20037 ? ? ? 3/3 ?
A. L. Rawlings 20079 ? ? ? 12/13 ?
Bradley R. Davis 201413 ? ? ? ? ?
图2 两组手术时间比较的Meta分析
图3 两组术中失血比较的Meta分析
图4 两组中转开腹率比较的Meta分析
图5 两组淋巴结清扫数比较的Meta分析
图6 两组术后并发症比较的Meta分析
图7 两组排气时间比较的Meta分析
图8 两组术后进食时间比较的Meta分析
图9 两组术后住院时间比较的Meta分析
图10 两组总住院费用比较的Meta分析
图11 两组既往手术史之间比较的Meta分析
图12 两组中乙状结肠切除术之间手术时间对比
图13 乙状结肠切除术之间中转开腹率对比
图14 良性病变手术患者中转开腹率对比
图15 恶性病变手术时间对比
图16 恶性病变术中失血对比
图17 恶性病变住院时间对比
图18 术后并发症的发表偏倚漏斗图
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