机器人辅助与传统腹腔镜胆囊切除术治疗良性胆囊疾病 疗效比较的Meta 分析
| 作者: |
1,2,3韩彩文,
3,4姚亮,
3闫沛静,
5,6李美萱,
1,2,3金大成,
1,3蔡辉,
3,5杨克虎,
7刘荣,
1,3,5郭天康
1 甘肃省人民医院 普通外科，甘肃 兰州 730000 2 甘肃中医药大学 临床医学院，甘肃 兰州 730000 3 甘肃省人民医院 临床研究与循证医学研究所，甘肃 兰州 730000 4 香港浸会大学 中医药学院，中国 香港 9990773 5 兰州大学 循证医学中心，甘肃 兰州 730000 6 兰州大学 公共卫生学院，甘肃 兰州 730000 7 中国人民解放军总医院 肝胆胰肿瘤外科，北京 100853 |
| 通讯: |
刘荣
Email: liurong301@126.com 郭天康 Email: TiankangGuo2018@163.com |
| DOI: | 10.3978/.2018.08.003 |
| 基金: | 甘肃省循证医学与临床转化重点实验室基金资助项目（lcxz006）；甘肃省兰州市科技局指导性计划基金资助 （2017-ZD-38）。 |
摘要
目的：比较机器人辅助腹腔镜胆囊切除术（RAC）与传统腹腔镜胆囊切除术（TLC）治疗良性胆囊疾病的疗效。
方法：系统检索文献数据库，按照纳入、排除标准筛选符合标准的文献，用 RevMan 5.3 软件进行 Meta分析。
结果：纳入 26 篇文献，共 4 004 例患者，其中 1 833 例行 RAC，2 171 例行 TLC。Meta 分析结果显示，与 TLC 比较，RAC 的手术时间延长（MD=13.14，95% CI=4.79~21.50，P=0.002）、切口疝发生率升高（RR=3.59，95% CI=1.77~7.28，P=0.0004）、术中中转开腹率降低（RR=0.60，95% CI=0.40~0.92， P=0.02）。而在术中并发症、术后并发症、30 d 再入院率、住院时间、失血量等方面，两者之间均无统计学差异（均 P>0.05）。
结论：当前的证据表明，RAC 具有与 TLC 相似的安全性和有效性但并不比 TLC 有优势。
关键词：
胆囊切除术；机器人手术；腹腔镜；Meta 分析
方法：系统检索文献数据库，按照纳入、排除标准筛选符合标准的文献，用 RevMan 5.3 软件进行 Meta分析。
结果：纳入 26 篇文献，共 4 004 例患者，其中 1 833 例行 RAC，2 171 例行 TLC。Meta 分析结果显示，与 TLC 比较，RAC 的手术时间延长（MD=13.14，95% CI=4.79~21.50，P=0.002）、切口疝发生率升高（RR=3.59，95% CI=1.77~7.28，P=0.0004）、术中中转开腹率降低（RR=0.60，95% CI=0.40~0.92， P=0.02）。而在术中并发症、术后并发症、30 d 再入院率、住院时间、失血量等方面，两者之间均无统计学差异（均 P>0.05）。
结论：当前的证据表明，RAC 具有与 TLC 相似的安全性和有效性但并不比 TLC 有优势。
Meta-analysis of robotic-assisted versus conventional laparoscopic cholecystectomy for benign gallbladder diseases
CorrespondingAuthor:LIU Rong Email: liurong301@126.com
Abstract
Objective: To compare the clinical efficacy of robotic-assisted cholecystectomy (RAC) and traditional laparoscopic cholecystectomy (TLC) in treatment of benign gallbladder diseases.
Methods: After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria. After data extraction, Meta-analysis was performed by using RevMan 5.3 software.
Results: Twenty-six studies were finally included, involving 4 004 patients, of whom, 1 833 cases underwent RAC and 2 171 cases underwent TLC. The results of Meta-analysis showed that RAC had prolonged operative time (MD=13.14, 95% CI=4.79–21.50, P=0.002) and increased incidence of incisional hernia (RR=3.59, 95% CI=1.77–7.28, P=0.0004), but reduced intraoperative conversion rate (RR=0.60, 95% CI=0.40–0.92, P=0.02) compared with TLC. However, no significant differences were found in intraoperative complications, postoperative complications, 30 d readmission rate, length of hospital stay and blood loss between the two procedures (all P>0.05).
Conclusion: Current evidence suggests that RAC has similar safety and effectiveness as TLC, but no advantage over TLC.
Keywords：
Cholecystectomy; Robotic Surgical Procedures; Laparoscopes; Meta-Analysis
Methods: After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria. After data extraction, Meta-analysis was performed by using RevMan 5.3 software.
Results: Twenty-six studies were finally included, involving 4 004 patients, of whom, 1 833 cases underwent RAC and 2 171 cases underwent TLC. The results of Meta-analysis showed that RAC had prolonged operative time (MD=13.14, 95% CI=4.79–21.50, P=0.002) and increased incidence of incisional hernia (RR=3.59, 95% CI=1.77–7.28, P=0.0004), but reduced intraoperative conversion rate (RR=0.60, 95% CI=0.40–0.92, P=0.02) compared with TLC. However, no significant differences were found in intraoperative complications, postoperative complications, 30 d readmission rate, length of hospital stay and blood loss between the two procedures (all P>0.05).
Conclusion: Current evidence suggests that RAC has similar safety and effectiveness as TLC, but no advantage over TLC.