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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (05) : 505 -513. doi: 10.3877/cma.j.issn.2095-3224.2021.05.010

论著

机器人和腹腔镜直肠癌根治术近期疗效的Meta分析
王素1, 孙振青2, 刘小雷2, 苏萌萌2, 王东升2,†(), 种瑞峰1   
  1. 1. 266109　青岛大学第十五临床医学院普外科
    2. 266003　青岛大学附属医院胃肠外科
  • 收稿日期:2020-08-17 出版日期:2021-10-25
  • 通信作者: 王东升

Short term efficacy of robotic versus laparoscopic surgery for rectal cancer: a meta-analysis

Su Wang1, Zhenqing Sun2, Xiaolei Liu2, Mengmeng Su2, Dongsheng Wang2,†(), Ruifeng Chong1   

  1. 1. Department of General Surgery, the Fifteenth Clinical College of Qingdao University, Qingdao 266109, China
    2. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Received:2020-08-17 Published:2021-10-25
  • Corresponding author: Dongsheng Wang
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引用本文：

王素, 孙振青, 刘小雷, 苏萌萌, 王东升, 种瑞峰. 机器人和腹腔镜直肠癌根治术近期疗效的Meta分析[J]. 中华结直肠疾病电子杂志, 2021, 10(05): 505-513.

Su Wang, Zhenqing Sun, Xiaolei Liu, Mengmeng Su, Dongsheng Wang, Ruifeng Chong. Short term efficacy of robotic versus laparoscopic surgery for rectal cancer: a meta-analysis[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(05): 505-513.

目的

通过Meta分析的方法比较机器人直肠癌根治术与腹腔镜直肠癌根治术的安全性、可行性与近期疗效。

方法

检索包括Pubmed、EMBASE、Cochrane Library、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据、维普数据库在内的数据库。检索时间为建库至2020年3月。用NOS评分系统评价文献质量。用Review Manager 5.3软件进行统计分析。

结果

最终纳入符合标准的相关文献9篇，纳入患者1 527例，其中达芬奇机器人辅助直肠癌根治术（RP）组786例（51.5%）、腹腔镜辅助直肠癌根治术（LP）组741例（48.5%）。分析结果显示：与LP组相比，RP组手术时间长（WMD=36.74，95%CI=7.84~65.64，P=0.01＜0.05），RP组平均术中失血量少（WMD=-20.92，95% CI=-34.56~-7.28，P=0.003），平均住院时间缩短（WMD=0.85，95% CI=-1.37~-0.33，P=0.001），中转开腹率低（WMD=0.44，95% CI=0.20~0.98，P=0.04）。在淋巴结获取数目、肿瘤距远端切缘距离、术后首次排气时间、造口率、术后并发症总发生率等方面两组间差异均无统计学意义（均P＞0.05）。

结论

机器人直肠癌根治术可减少术中失血量、降低中转开腹率、缩短平均住院时间，但在淋巴结获取数目、肿瘤距远端切缘距离、术后首次排气时间、造口率、术后并发症总发生率等方面无明显优势。

关键词: 直肠肿瘤, 机器人, 腹腔镜, Meta分析
Objective

A meta-analysis was conducted to evaluate and compare the safety, feasibility and short-term efficacy between robotic and laparoscopic radical resection of rectal cancer.

Methods

A literature search was performed including Pubmed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese CNKI, Wanfang and VIP database. The retrieval time was set up to March 2020. NOS score system was used to evaluate literature quality. Statistical analysis was performed using Review Management 5.3 software.

Results

There were 9 relevant literatures that matched the standards, a total of 1 527 patients were included. There were 786 cases (51.5%) in RP group and 741 cases (48.5%) in LP group. The results showed that compared with LP group, RP group had a longer operative time (WMD=36.74, 95%CI=7.84~65.64, P=0.01＜0.05), less intraoperative blood loss (WMD=-20.92, 95% CI=-34.56~-7.28, P=0.003), shorter average length of hospital stay (WMD=0.85, 95% CI=-1.37~0.33, P=0.001), and lower conversion rate(WMD=0.44, 95% CI=0.20~0.98, P=0.04). There were no statistically significant differences between the two groups in the number of lymph nodes acquired, the distance between the tumor and the distal cutting edge, the time of first postoperative exhaust, the rate of stoma, and the total incidence of postoperative complications (all P＞0.05).

Conclusion

The robotic of rectal cancer can reduce intraoperative blood loss, reduce the rate of conversion rate, and shorten the average hospital stay, but it has no obvious advantages in the number of lymph nodes acquired, the distance between tumor and distal resection margin, the time of first postoperative exhaust, the rate of stoma, and the total incidence of postoperative complications.

Key words: Rectal neoplasms, Robotic surgery, Laparoscopic surgery, Meta analysis
图1 文献筛选流程图
表1 纳入研究文献的基本特征
第一作者 年份 国家 组别 例数

性别

（男/女）

年龄

（岁）

BMI

（kg/m2）

 术前新辅助（例）

ASA评分

（Ⅰ/Ⅱ/Ⅲ/Ⅳ）

 NOS评分
Pierre-Emmanuel Colombo［5］ 2016 法国 RP 60 40/20 62 25.8 47 20/30/9/1 6
LP 60 42/18 60 23.8 39 18/32/10/0
Soo Yeun Park［6］ 2013 韩国 RP 40 28/12 57.3±12.1 23.9±2.4 32 27/9/4/0 7
LP 40 25/15 63.6±10.6 24.1±3.1 20 24/14/2/0
Deniz Atasoy［7］ 2018 土耳其 RP 45 34/11 63±9 27±4 16 2（1~3） 6
LP 62 34/28 59±11 27±5 21 2（1~4）
Seung Hyuk Baik［8］ 2009 韩国 RP 56 37/19 60（60.3±8.3） 23.4 5 41/14/1/0 7
LP 57 34/23 64（63.2±10.4） 23 7 31/22/3/1
Byung-Eun Yoo［9］ 2015 韩国 RP 44 35/9 59.77±12.33 24.13±3.33 24 26/17/1/0 7
LP 26 19/7 60.5±10.75 21.42±3.13 7 15/11/0/0
D. Kamali［10］ 2017 英国 RP 18 13/5 73±11 未描述 7 0/8/10/0 6
LP 18 11/7 66±11 未描述 10 0/16/2/0
David Jayne［11］ 2017 英国 RP 237 161/76 64.4±10.98 细分 111 39/150/46/0 8
LP 234 159/75 65.5±11.93 细分 108 52/124/52/1
Min Jung Kim［12］ 2018 韩国 RP 66 51/15 90.4±9.7 24.1±3.3 51 20/46/0/0 7
LP 73 52/21 59.7±11.7 23.6±3.0 58 30/43/0/0
Wai Lun Law［13］ 2016 中国 RP 220 148/72 65 24.9 91 26/147/47/0 6
LP 171 97/74 67 24.6 50 20/103/35/0
图2 机器人组与腹腔镜组直肠癌根治术手术时间的Meta分析结果
图3 机器人组与腹腔镜组直肠癌根治术术中失血量的Meta分析结果
图4 机器人组与腹腔镜组直肠癌根治术中转开腹率的Meta分析结果
图5 机器人组与腹腔镜组直肠癌根治术平均住院时间的Meta分析结果
图6 机器人组与腹腔镜组直肠癌根治术造口率的Meta分析结果
图7 机器人组与腹腔镜组直肠癌根治术肿瘤距远端切缘距离的Meta分析结果
图8 机器人组与腹腔镜组直肠癌根治术淋巴结获取数的Meta分析结果
图9 机器人组与腹腔镜组直肠癌根治术术后首次排气时间的Meta分析结果
图10 机器人组与腹腔镜组直肠癌根治术术后并发症总发生率的Meta分析结果
图11 机器人组与腹腔镜组直肠癌根治术术后常见并发症亚组的Meta分析结果
图12 术后总并发症发生率漏斗图
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