The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of r...The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.展开更多
目的比较腹腔镜胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)中一期缝合与T管引流在胆总管结石患者中的应用效果。方法回顾性分析2017年2月至2019年2月上海健康医学院附属周浦医院收治的82例胆总管结石患者,并...目的比较腹腔镜胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)中一期缝合与T管引流在胆总管结石患者中的应用效果。方法回顾性分析2017年2月至2019年2月上海健康医学院附属周浦医院收治的82例胆总管结石患者,并根据手术方案将其分为A组(39例)和B组(43例),A组采用LCBDE术中一期缝合治疗,B组采用LCBDE术中T管引流治疗;统计两组的手术时间、术中出血量、拔管时间、胃肠道恢复时间以及住院总时间;比较两组治疗前、后的血清白细胞介素-1β(IL-1β)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)等炎性因子水平变化情况及两组术后总并发症发生率。结果 A组的手术时间、胃肠道恢复时间以及住院时间均短于B组,差异具有统计学意义(P<0.05),两组患者的术中出血量、拔管时间比较,差异无统计学意义(P>0.05);A组治疗后,血清IL-1β、CRP和TNF-α水平均低于B组,差异具有统计学意义(P<0.05);A组的总并发症发生率(7.69%)与B组(13.95%)比较,差异无统计学意义(P>0.05)。结论 LCBDE术中一期缝合相比T管引流能够显著缩短手术时间、胃肠道恢复时间以及住院时间,改善患者炎性因子表达水平。展开更多
基金the National Key Research and Development Program of China(grand number 2017YFC0110405)the National Natural Science Foundation of China(grant number 81500499).
文摘The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.
文摘目的比较腹腔镜胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)中一期缝合与T管引流在胆总管结石患者中的应用效果。方法回顾性分析2017年2月至2019年2月上海健康医学院附属周浦医院收治的82例胆总管结石患者,并根据手术方案将其分为A组(39例)和B组(43例),A组采用LCBDE术中一期缝合治疗,B组采用LCBDE术中T管引流治疗;统计两组的手术时间、术中出血量、拔管时间、胃肠道恢复时间以及住院总时间;比较两组治疗前、后的血清白细胞介素-1β(IL-1β)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)等炎性因子水平变化情况及两组术后总并发症发生率。结果 A组的手术时间、胃肠道恢复时间以及住院时间均短于B组,差异具有统计学意义(P<0.05),两组患者的术中出血量、拔管时间比较,差异无统计学意义(P>0.05);A组治疗后,血清IL-1β、CRP和TNF-α水平均低于B组,差异具有统计学意义(P<0.05);A组的总并发症发生率(7.69%)与B组(13.95%)比较,差异无统计学意义(P>0.05)。结论 LCBDE术中一期缝合相比T管引流能够显著缩短手术时间、胃肠道恢复时间以及住院时间,改善患者炎性因子表达水平。
