专题研究(Monographic Study)

达芬奇机器人与腹腔镜手术治疗胃癌疗效比较的Meta分析

Published at: 2017年第26卷第4期

王沛云 1 , 熊兵红 1 , 曾玉剑 1 , 田衍 1 , 王昆华 1,2 , 罗华友 1,2
1 昆明医科大学第一附属医院 胃肠外科,云南 昆明 650032
2 云南省消化病研究所,云南 昆明 650032
通讯作者 华友 罗 Email: 1677546296@qq.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.04.003
基金:
云南省科技计划资助项目 2014FB021
云南省卫生科技计划资助项目 2014NS124;2016NS003

摘要

目的:系统评价达芬奇机器人胃癌手术的有效性、安全性与近远期疗效。方法:检索国内外数据库,收集比较达芬奇机器人胃癌手术与传统腹腔镜胃癌手术的文献,对获得的数据用RevMan 5.2软件进行Meta分析。结果:纳入17篇文献,共5 787例患者,其中机器人手术1 676例,传统腹腔镜手术4 111例。Meta分析结果显示,与传统腹腔镜手术比较,机器人手术所用时间延长(WMD=43.51,95% CI= 34.14~52.88,P<0.05)、术中失血量减少(WMD=-30.17,95% CI=-42.83~-17.51,P<0.05)、淋巴结清扫数目增加(WMD=1.95,95% CI=0.07~3.84,P<0.05)、首次进食时间提前(WMD=-0.22,95% CI=-0.32~-0.12,P<0.05),而其他指标包括近远端切缘距离、R0切除率、中转率、术后首次排气时间、术后住院时间、并发症发生率、病死率、3年生存率均相似(均P>0.05)。结论:达芬奇机器人胃癌手术安全、有效,且有较好的近远期疗效。


Meta-analysis of da Vinci robotic versus laparoscopic gastrectomy for gastric cancer

Abstract

Objective: To systematically evaluate the safety and efficacy of da Vinci robotic gastrectomy for gastric cancer. Methods: Literature on studies comparing da Vinci robotic gastrectomy and traditional laparoscopic gastrectomy was selected through searching several national and international databases. After data extraction, Meta-analysis was performed by using RevMan 5.2 software. Results: Seventeen studies were finally included in the analysis, involving 5 787 patients, of whom, 1 676 cases underwent da Vinci robotic gastrectomy and 4 111 cases underwent traditional laparoscopic gastrectomy. Results of Meta-analysis showed that da Vinci robotic gastrectomy compared with traditional laparoscopic gastrectomy, the operative time was prolonged (WMD=43.51, 95% CI=34.14–52.88, P<0.05), blood loss was reduced (WMD=–30.17, 95% CI=–42.83––17.51, P<0.05), number of harvested lymph nodes was increased (WMD=1.95, 95% CI=0.07-3.84, P<0.05) and time to first postoperative food intake shortened (WMD=–0.22, 95% CI=–0.32––0.12, P<0.05), while the other variables that included the proximal and distal margin, R0 resection rate, conversion rate, time to first postoperative gas passage, length of postoperative hospital stay, incidence of postoperative complications, mortality rate, and 3-year overall survival rate were all similar (all P>0.05). Conclusion: da Vinci robotic gastrectomy is safe and effective in treatment of gastric cancer, with better short- and long-term efficacy.


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引用

引用本文: 沛云 王, 兵红 熊, 玉剑 曾, 衍 田, 昆华 王, 华友 罗. 达芬奇机器人与腹腔镜手术治疗胃癌疗效比较的Meta分析 [J]. 中国普通外科杂志, 2017, 26(4): 412-424.
Cite this article as: WANG Peiyun, XIONG Binghong, ZENG Yujian, TIAN Yan, WANG Kunhua, LUO Huayou . Meta-analysis of da Vinci robotic versus laparoscopic gastrectomy for gastric cancer[J]. Chin J Gen Surg, 2017, 26(4): 412-424.