摘要
目的系统评价达芬奇机器人辅助胸腔镜手术(robot-assisted thoracoscopic surgery,RATS)与电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗纵隔肿瘤的临床效果。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、SinoMed、中国知网及万方数据库,筛选有关RATS与VATS治疗纵隔肿瘤临床效果比较的文献,检索时限为建库至2022年10月10日。由2名检索人员独立筛选文献、提取相关数据。对纳入文献采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评价。使用RevMan 5.3软件进行Meta分析。结果共纳入23个研究,包括5646例患者,NOS评分均≥6分。Meta分析结果显示,与VATS组相比,RATS组术中失血量更少[MD=−18.11,95%CI(−26.12,−10.09),P<0.001],术后引流管留置时间[MD=−0.79,95%CI(−1.09,−0.49),P<0.001]和术后住院时间[MD=−1.00,95%CI(−1.36,−0.64),P<0.001]更短,术后第1 d引流量[MD=−5.53,95%CI(−9.94,−1.12),P=0.010]和术后引流总量[MD=−88.41,95%CI(−140.85,−35.97),P=0.001]更少,术后并发症发生率[OR=0.66,95%CI(0.46,0.94),P=0.020]和术中中转开胸率[OR=0.32,95%CI(0.19,0.53),P<0.001]更低,住院费用更高[MD=2.60,95%CI(1.40,3.79),P<0.001]。两组手术时间差异无统计学意义[MD=5.94,95%CI(−1.45,13.34),P=0.120]。结论RATS辅助纵隔肿瘤切除术具有较高的安全性。与VATS相比,患者术中失血量更少、中转开胸率更低、术后置管时间及住院时间更短,更有利于患者术后快速康复。
Objective To systematically evaluate of the difference in clinical outcomes between Da-Vinci robotassisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)for mediastinal tumor resection.Methods Online databases including The Cochrane Library,PubMed,EMbase,Web of Science,SinoMed,CNKI,and Wanfang were searched by two researchers independently from inception to October 10,2022.The quality of the included literature was evaluated using the Newcastle-Ottawa Scale(NOS).The meta-analysis was performed by RevMan 5.3.Results A total of 23 studies with 5646 patients were enrolled in the final study.The NOS scores of the studies were≥6 points.The results of meta-analysis showed that compared with the VATS group,the blood loss was less[MD=−18.11,95%CI(−26.12,−10.09),P<0.001],time of postoperative drainage tube retention[MD=−0.79,95%CI(−1.09,−0.49),P<0.001]and postoperative hospitalization time[MD=−1.00,95%CI(−1.36,−0.64),P<0.001]were shorter,postoperative day 1 drainage[MD=−5.53,95%CI(−9.94,−1.12),P=0.010]and total postoperative drainage[MD=−88.41,95%CI(−140.85,−35.97),P=0.001]were less,the rates of postoperative complications[OR=0.66,95%CI(0.46,0.94),P=0.020]and conversion to thoracotomy[OR=0.32,95%CI(0.19,0.53),P<0.001]were lower,and the hospitalization costs were higher[MD=2.60,95%CI(1.40,3.79),P<0.001]in the RATS group.The operative time was not statistically different between the two groups[MD=5.94,95%CI(−1.45,13.34),P=0.120].Conclusion RATS mediastinal tumor resection has a high safety profile.Compared with VATS,patients have less intraoperative blood loss,a lower rate of conversion to thoracotomy,and shorter postoperative tube time and hospital stay,which is more conducive to rapid postoperative recovery.
作者
曾伟强
党海丽
苟云久
ZENG Weiqiang;DANG Haili;GOU Yunjiu(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou,730000,P.R.China;Department of Gastroenterology,Longnan Hospital of Traditional Chinese Medicine,Longnan,746000,Gansu,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
2024年第8期1190-1197,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
甘肃省中医药科研课题(GZKZ-2020-1)
甘肃省人民医院国家自然科学基金抚育项目(19SYPYB-28
19SYPYB-16)。
关键词
机器人辅助胸腔镜手术
电视辅助胸腔镜手术
纵隔肿瘤
微创手术
系统评价/META分析
Robot-assisted thoracoscopic surgery
video-assisted thoracoscopic surgery
mediastinal tumor
minimally invasive surgery
systematic review/meta-analysis
