摘要
目的系统评价机器人对比腹腔镜及开放式腹股沟疝修补术的安全性与有效性。方法检索Cochrane Library、PubMed、MEDLINE、Web of Science核心合集以及知网与万方数据库中发表的2000年1月至2024年7月的临床对照研究,并按照纳入排除标准进行筛选。2名独立研究人员使用纽卡斯尔-渥太华量表(NOS)或Jadad量表进行文献质量评价并随后进行数据提取。使用R中“meta”包(V6.0.0)进行数据分析。结果最终纳入26项研究进行数据整合,共计17354例患者,其中机器人腹股沟疝修补术4813例,开放式手术5870例、腹腔镜手术6671例。机器人手术的术后并发症发生率、复发率、再入院率、血肿发生率与开放式手术及腹腔镜手术相比,差异均无统计学意义(P>0.05)。但机器人手术组平均手术时间更长、住院费用更高[机器人比腹腔镜SMD=22.40,95%CI(15.43~29.37),P<0.01;机器人比开放式SMD=1.19,95%CI(0.71~1.68),P<0.01]。机器人手术的住院时间较开放式手术更短[SMD=-0.47,95%CI(-0.84~-0.09),P=0.01],但与腹腔镜手术比较,差异无统计学意义[SMD=0.17,95%CI(-0.07~0.40),P=0.16]。此外,机器人手术的疼痛率较腹腔镜手术低,差异有统计学意义[OR=0.50,95%CI(0.25~1.01),P=0.05]。结论机器人腹股沟疝修补术是一种安全有效的手术方式,其住院时间较开放手术、疼痛率较腹腔镜手术具有一定优势,但仍需进一步研究证实。
Objective To systematically evaluate the safety and efficacy of robotic surgery compared to laparoscopic and open inguinal hernia repair.Methods A comprehensive search was conducted in the Cochrane Library,PubMed,MEDLINE,Web of Science Core Collection,CNKI and Wanfang databases for clinical controlled trials published from January 2000 to July 2024.Studies were screened based on predefined inclusion and exclusion criteria.Two independent researchers assessed the quality of the literature using the Newcastle-Ottawa Scale(NOS)or the Jadad scale,and conducted the subsequent data extraction.Data analysis was performed using the“meta”package(version 6.0.0)in R.Results A total of 26 studies were included in the data analysis,including 17354 patients:4813 underwent robotic inguinal hernia repair,5870 underwent open surgery,and 6671 underwent laparoscopic surgery.Compared to open and laparoscopic surgeries,robotic surgery showed no significant differences in postoperative complication rate,recurrence rate,readmission rate,or hematoma occurrence(All P values>0.05).However,the robotic surgery group exhibited longer operative times and higher costs[Robotic vs Laparoscopic:SMD=22.40,95%CI(15.43-29.37),P<0.01;Robotic vs Open:SMD=1.19,95%CI(0.71-1.68),P<0.01].In comparison to open surgery,robotic surgery had shorter hospital stays[SMD=-0.47,95%CI(-0.84--0.09),P=0.01],but there was no statistically significant difference when compared to laparoscopic surgery[SMD=0.17,95%CI(-0.07-0.40),P=0.16].Additionally,robotic surgery demonstrated a significant lower pain rate compared to laparoscopic surgery[OR=0.50,95%CI(0.25-1.01),P=0.05].Conclusion Robotic inguinal hernia repair is a safe and effective surgical approach.Its advantages in terms of hospital stay compared to open surgery and pain rates compared to laparoscopic surgery warrant further investigation to confirm.
作者
孙昭
刘琪
王殿琛
姜建武
符洋
Zhao Sun;Qi Liu;Dianchen Wang;Jianwu Jiang;Yang Fu(Department of Hernia and Abdominal Wall Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,Henan Province,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2024年第5期588-598,共11页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
河南省高等学校重点科研项目计划(22A320053)
吴阶平医学基金会临床科研专项资助基金(320.6750.2022-7-9)。
关键词
疝
腹股沟
疝修补术
机器人手术
荟萃分析
并发症
Hernia,inguinal
Herniorrhaphy
Robotic surgery
Meta-analysis
Complications
