摘要
目的系统评价机器人辅助与胸腔镜辅助胸腺切除术的疗效及安全性。方法计算机检索Web of Science、PubMed、EMbase、The Cochrane Library、万方、维普和中国知网数据库,搜索建库至2022年2月公开发表的比较机器人辅助与胸腔镜辅助胸腺切除术疗效及安全性的相关文献。采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对纳入的队列研究进行质量评价,采用Review Manager 5.4软件对文献进行Meta分析。结果共纳入16篇文献,均为回顾性队列研究,共计1793例患者,其中机器人辅助胸腺切除术组874例,胸腔镜辅助胸腺切除术组919例。纳入文献NOS评分均≥7分。Meta分析结果显示,与胸腔镜辅助胸腺切除术相比,机器人辅助胸腺切除术术中出血量更少[MD=−22.45,95%CI(−34.16,−10.73),P<0.001]、术后胸腔引流量更少[MD=−80.29,95%CI(−144.86,−15.72),P=0.010]、术后引流时间更短[MD=−0.69,95%CI(−1.08,−0.30),P<0.001]、术后住院时间更短[MD=−1.14,95%CI(−1.55,−0.72),P<0.001]且中转开胸更少[OR=0.40,95%CI(0.23,0.69),P=0.001];但两组手术时间[MD=8.37,95%CI(−1.21,17.96),P=0.090]、术后重症肌无力危象发生率[OR=0.85,95%CI(0.52,1.40),P=0.530]、术后总并发症发生率[OR=0.80,95%CI(0.42,1.50),P=0.480]和肿瘤大小[MD=−0.18,95%CI(−0.38,0.03),P=0.090]差异无统计学意义。结论机器人辅助胸腺切除术在术中出血量、术后胸腔引流量、术后引流时间、术后住院时间和中转开胸方面比胸腔镜辅助胸腺切除术更具优势。
Objective To evaluate the efficacy and safety of robot-assisted thymectomy(RATS)versus videoassisted thoracoscopic thymectomy(VATS).Methods Web of Science,PubMed,EMbase,The Cochrane Library,Wanfang,VIP and CNKI databases were searched by computer from inception to February 2022.Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of included cohort studies,and Review Manager 5.4 software was utilized to perform a metaanalysis.Results A total of 16 retrospective cohort studies were included,covering a total of 1793 patients(874 patients in the RATS group and 919 patients in the VATS group).The NOS scores of the included studies were≥7 points.Metaanalysis results revealed that RATS had less intraoperative bleeding(MD=−22.45,95%CI−34.16 to−10.73,P<0.001),less postoperative chest drainage(MD=−80.29,95%CI−144.86 to−15.72,P=0.010),shorter postoperative drainage time(MD=−0.69,95%CI−1.08 to−0.30,P<0.001),shorter postoperative hospital stay(MD=−1.14,95%CI−1.55 to−0.72,P<0.001)and fewer conversion to thoractomy(OR=0.40,95%CI 0.23 to 0.69,P=0.001)than VATS;whereas,the operative time(MD=8.37,95%CI−1.21 to 17.96,P=0.090),incidence of postoperative myasthenia gravis(OR=0.85,95%CI 0.52 to 1.40,P=0.530),overall postoperative complications rate(OR=0.80,95%CI 0.42 to 1.50,P=0.480)and tumour size(MD=−0.18,95%CI−0.38 to 0.03,P=0.090)were not statistically different between the two groups.Conclusion In the aspects of intraoperative bleeding,postoperative chest drainage,postoperative drainage time,postoperative hospital stay and conversion to thoracotomy,RATS has unique advantages over the VATS.
作者
洪子强
金大成
白向豆
成涛
吴旭升
崔百强
苟云久
HONG Ziqiang;JIN Dacheng;BAI Xiangdou;CHENG Tao;WU Xusheng;CUI Baiqiang;GOU Yunjiu(The First Clinical Department of Gansu University of Traditional Chinese Medicine,Lanzhou,730000,P.R.China;Department of Thoracic Surgery,Gansu Provincial Hospital,Lanzhou,730000,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第10期1458-1466,共9页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
甘肃省人民医院国家自然科学基金抚育项目(19SYPYB-28)
甘肃省自然科学基金(20JR10RA388)
甘肃省卫生健康行业科研管理项目(GSWSKY2020-50)。
