摘要
目的本研究旨在通过Meta分析方法评估机器人辅助手术(robot-assisted surgery,RAS)用于切除胆总管囊肿(choledochal cysts,CCs)的安全性与有效性,以获得循证医学支持为临床提供参考。方法检索PubMed、EMBASE、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网(VIP)和CBM数据库,检索时间为建库至2022年5月1日。使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评估,RevMan(5.4版)进行Meta分析,使用漏斗图法识别是否存在发表性偏移。结果共纳入9项研究,包括623例患者。Meta分析结果显示与腹腔镜手术(laparoscopicassisted surgery,LAS)比较,RAS术中失血量更少(MD=-10.10,95%CI:-17.8~-2.40,P=0.010)、术后首次进食时间更早(MD=-0.46,95%CI:-0.86~-0.06,P=0.030)、住院时间更短(MD=-1.09,95%CI:-1.93~-0.26,P=0.010)和并发症发生率更低(OR=0.41,95%CI:0.21~0.79,P=0.008)。两组的手术时间比较,差异无统计学意义(MD=29.11,95%CI:-12.74~70.97,P=0.170),但RAS的总费用更高(MD=27.25,95%CI:11.79~42.72,P=0.0006)。亚组分析显示,在儿童组中,RAS比LAS有明显的优势:出血量小(P=0.030),住院时间短(P=0.020),术后并发症少(P=0.040)。结论现有证据表明,RAS在治疗胆总管囊肿方面具有术中出血少、组织损伤小、恢复快、愈合好等优点,证明RAS是安全可行的。特别是在儿童组,RAS似乎是一个更好的选择。
Objective The aim of this study was to evaluate the safety and efficacy of robot-assisted surgery(RAS)for resection of common bile duct cysts by Meta-analysis method to obtain evidence-based clinical reference.Methods PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,WanFang,VIP,and CBM were searched from database inception until May 1,2022.The Newcastle-Ottawa scale(NOS)was used to conduct quality assessments,and RevMan(Version 5.4)was used to perform the Meta-analysis,the funnel plot method was used to identify the presence or absence of publication bias.Results A total of 9studies,involving 623 patients,were included in the Meta-analysis.Compared with laparoscopicassisted surgery(LAS),RAS was associated with less intraoperative blood loss(mean difference,MD=-10.10,95%CI:-17.8--2.40,P=0.010),shorter time to start solid diets(MD=-0.46,95%CI:-0.86--0.06,P=0.030),shorter postoperative hospital stay(MD=-1.09,95%CI:-1.93--0.26,P=0.010),and lower risk of complications(OR=0.41,95%CI:0.21-0.79,P=0.008).There was no significant difference in operative time between the two groups(MD=29.11,95%CI:-12.74-70.97,P=0.170),but the total costs were higher in RAS(MD=27.25,95%CI:11.79-42.72,P=0.0006).Our subgroup analysis showed that in the child group,RAS had significant advantages over LAS:minor bleeding(P=0.030),shorter length of hospital stay(P=0.020),and fewer postoperative complications(P=0.040).Conclusion The available evidence indicated that advantages of the RAS system include less intraoperative blood loss,minor tissue damage,quick recovery,and sound healing in treating choledochal cyst,which showed that the RAS is safe and feasible.Especially in child group,RAS tends to be a better choice.
作者
李雄
田宏伟
苗长丰
龚世怡
雷婷
郭天康
LI Xiong;TIAN Hongwei;MIAO Changfeng(Ningxia Medical University,Ningxia 750000,China)
出处
《医学研究杂志》
2023年第5期98-105,共8页
Journal of Medical Research
基金
甘肃省自然科学基金资助项目(21JR7RA622,20JR10RA403)。
