达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌疗效的Meta分析

摘要

Objective To compare the efficacies of da Vinci robotic and traditional laparoscopic resection for colorectal cancer.Methods Databases including Pubmed,Cochrane Library,EMBASE,Medline,Wanfang,CNKI,VIP and FMJS were searched,and literatures published before February 2012 were retrieved.Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) focusing the comparison between da Vinci robotic and laparoscopic resection for colorectal cancer were collected.All the literatures retrieved were screened according to preset standards,and the patients were divided into robotic group and laparoscopic group.A meta analysis on the effectiveness of robotic and laparoscopic surgery for colorectal cancer was carried out using the RevMan 5.1 software.Categorical variables were presented by odds ratio (OR) and 95％ confidence interval (95 ％ CI),continuous variables were presented by weighted mean difference (WMD) and 95 ％ CI.Results One RCT and 10 NRCTs including 974 patients with colorectal cancer were screened out and there were 426 patients in the robotic group and 548 patients in the laparoscopic group.Compared with conventional laparoscopic surgery,longer operation time,lower rate of conversion to laparotomy and shorter anal exsufflation time were observed in the robotic group (WMD =25.61,OR =0.32,WMD =-0.21,P ＜ 0.05).There were no significant differences in the operative blood loss,number of lymph node dissected,distal resection margin,morbidity and duration of hospital stay between the robotic group and the laparoscopic group (WMD =-23.14,-0.31,0.14,OR =1.06,WMD =-0.43,P ＞ 0.05).Conclusion The efficacies of da Vinci robotic and laparoscopic surgery for the treatment of colorectal cancer are comparable,while da Vinci robotic surgery has the features of lower rate of conversion to laparotomy and shorter anal exsufflation time.%目的 比较达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的疗效.方法 检索PubMed、Cochrane Library、EMBASE、Medline、万方、知网、维普、康健等数据库,并检索纳入文献的参考文献.检索时间从建库至2012年2月.收集达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的随机对照试验(RCT)和非随机对照试验(NRCT).按预设标准进行筛选并进行质量评价,将纳入文献的患者分为机器人组和传统腹腔镜组,提取数据后用RevMan5.1软件进行Meta分析,比较两种手术方式治疗结直肠癌的疗效.二分类变量采用优势比(OR)及95％可信区间(95％ CI)表示,连续性变量采用加权均数差(WMD)及95％ CI表示.结果 共纳入1个RCT及10个NRCT,共计结直肠癌患者974例,其中机器人组426例,传统腹腔镜组548例.Meta分析结果显示:与传统腹腔镜组比较,机器人组手术时间长、中转开腹率低、术后肛门排气时间短(WMD =25.61,OR =0.32,WMD =-0.21,P ＜0.05)；两组患者术中出血量、淋巴结检出数目、远切缘距肿瘤距离、并发症发生率及住院时间比较,差异无统计学意义(WMD=-23.14,-0.31,0.14,OR=1.06,WMD =-0.43,P ＞0.05).结论 达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的肿瘤切除情况无差异,但达芬奇机器人手术系统结直肠癌切除术具有中转开腹率较低、术后肛门排气时间较短等优势.