机器人辅助腹腔镜与开腹肝切除术治疗肝脏疾病效果比较的Meta分析

张斌; 罗德; 彭方毅; 方程; 淦宇; 贺凯; 李波; 夏先明; 苏松

doi:10.3969/j.issn.1001-5256.2020.08.020

机器人辅助腹腔镜与开腹肝切除术治疗肝脏疾病效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2020.08.020

1. 西南医科大学附属医院肝胆外科
2. 井研县人民医院普通外科

基金项目:

2017年第四批省级科技计划-重点研发计划项目(2017SZYZF0015)； 2016年第一批省级科技计划项目(2016JY0039)；泸州市人民政府—西南医科大学科技战略合作项目(2017LZXNYD-J07)；

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中图分类号: R657.3
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出版历程
- 出版日期: 2020-08-20

Clinical effect of robot-assisted laparoscopic hepatectomy versus open hepatectomy in treatment of liver diseases:A Meta-analysis

Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
目的本研究旨在比较机器人辅助腹腔镜肝切除术（RALH）与开腹肝切除术（OH）对肝脏疾病的治疗效果与安全性。方法通过计算机全面检索Web of Science、PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献、维普和万方数据库,筛选出比较RALH与OH治疗肝脏疾病的所有中英文文献,检索时间截至2020年2月。对纳入文献进行质量学评价后,采用Revman5.1软件进行Meta分析。结果经筛选后共纳入7篇研究,包括754例患者,其中RALH组328例,OH组426例。Meta分析结果显示,与OH组相比,RALH的手术时间较长[均值（MD）=59.41,95%可信区间（95%CI）:9.74～109.08,P=0.02];且输血率[相对危险度（RR）=2.24,95%CI:1.04～4.82,P=0.04]和肝门阻断率（RR=2.27,95%CI:1.37～3.75,P=0.001）较高;但住院时间（MD=-3.87,95%CI:-5.63～-2.12,P<0.001）较短,术后总体并发症（RR=0.58,95%CI:0.41～0.81,P=0.0...
- 肝切除术 /
- 腹腔镜检查 /
- 机器人手术 /
- Meta分析(主题)
Abstract:
ObjectiveTo investigate the clinical effect and safety of robot-assisted laparoscopic hepatectomy (RALH) versus open hepatectomy (OH) in the treatment of liver diseases. MethodsWeb of Science, PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data were searched for Chinese and English articles on RALH versus OH in the treatment of liver diseases published up to February 2020. The quality of the articles included was assessed, and RevMan 5.1 was used to perform the meta-analysis. ResultsSeven studies were included, with a total of 754 patients (328 patients in the RALH group and 426 in the OH group). The meta-analysis showed that compared with the OH group, the RALH group had a significantly longer time of operation (mean difference ［MD］=59.41, 95% confidence interval ［CI］: 9.74-109.08, P=0.02), significantly higher blood transfusion rate (relative risk ［RR］=2.24, 95%CI: 1.04-4.82, P=0.04) and rate of hepatic portal occlusion (RR=2.27, 95%CI: 1.37-3.75, P=0.001), a significantly shorter length of hospital stay (MD=-3.87, 95%CI: -5.63 to -2.12,P＜0.001), and significantly lower overall incidence rate of postoperative complications (RR=0.58, 95%CI: 0.41-0.81, P=0.001) and incidence rates of major postoperative complications (RR=0.45, 95%CI: 0.22-0.91, P=0.03). There was no significant difference in intraoperative blood loss between the two groups (P＞0.05). ConclusionFor hepatectomy, RALF can shorten the length of hospital stay and reduce postoperative complications, creating conditions for minimally invasive hepatectomy and rapid recovery.
- hepatectomy /
- laparoscopy /
- robotic surgical procedures /
- Meta-analysis as topic

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参考文献(27)

[1] JARNAGIN WR,GONEN M,FONG Y,et al. Improvement in perioperative outcome after hepatic resection:Analysis of1,803 consecutive cases over the past decade[J]. Ann Surg,2002,236(4):397-406; discussion 406-407.

[2] CARBAJO MA,MARTN DEL OLMO JC,BLANCO JI,et al.Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh[J]. Surg Endosc,1999,13(3):250-252.

[3] BUELL JF,CHERQUI D,GELLER DA,et al. The international position on laparoscopic liver surgery:The Louisville statement,2008[J]. Ann Surg,2009,250(5):825-830.

[4] REICH H,MCGLYNN F,DECAPRIO J,et al. Laparoscopic excision of benign liver lesions[J]. Obstet Gynecol,1991,78(5 Pt 2):956-958.

[5] DESCOTTES B,GLINEUR D,LACHACHI F,et al. Laparoscopic liver resection of benign liver tumors[J]. Surg Endosc,2003,17(1):23-30.

[6] TOMULESCU V,STNCIULEA O,BLESCU I,et al. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department:Indications,technique and results[J]. Chirurgia(Bucur),2009,104(2):141-150.

[7] SIMILLIS C,CONSTANTINIDES VA,TEKKIS PP,et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis[J]. Surgery,2007,141(2):203-211.

[8] TROISI RI,PATRITI A,MONTALTI R,et al. Robot assistance in liver surgery:A real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis[J].Int J Med Robot,2013,9(2):160-166.

[9] PIGAZZI A,LUCA F,PATRITI A,et al. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer[J]. Ann Surg Oncol,2010,17(6):1614-1620.

[10] JI WB,WANG HG,ZHAO ZM,et al. Robotic-assisted laparoscopic anatomic hepatectomy in China:Initial experience[J]. Ann Surg,2011,253(2):342-348.

[11] MOHER D,LIBERATI A,TETZLAFF J,et al. Preferred reporting items for systematic reviews and meta-analyses:The PRISMA statement[J]. Int J Surg,2010,8(5):336-341.

[12] HOU XW,SHI JP,CHEN X. How to estimate the mean and standard deviation based on the median,range and sample size when conducting meta-analysis[J]. Chin J Evid Based Med,2015,15:484-487.

[13] HOZO SP,DJULBEGOVIC B,HOZO I. Estimating the mean and variance from the median,range,and the size of a sample[J]. BMC Med Res Methodol,2005,5:13.

[14] STANG A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses[J]. Eur J Epidemiol,2010,25(9):603-605.

[15] PATRITI A,CIPRIANI F,RATTI F,et al. Robot-assisted versus open liver resection in the right posterior section[J].JSLS,2014,18(3):e2014.

[16] CRONER RS,PERRAKIS A,HOHENBERGER W,et al. Robotic liver surgery for minor hepatic resections:A comparison with laparoscopic and open standard procedures[J]. Langenbecks Arch Surg,2016,401(5):707-714.

[17] KINGHAM TP,LEUNG U,KUK D,et al. Robotic liver resection:A case-matched comparison[J]. World J Surg,2016,40(6):1422-1428.

[18] SHAM JG,RICHARDS MK,SEO YD,et al. Efficacy and cost of robotic hepatectomy:Is the robot cost-prohibitive?[J]. J Robot Surg,2016,10(4):307-313.

[19] CHEN PD,WU CY,HU RH,et al. Robotic versus open hepatectomy for hepatocellular carcinoma:A matched comparison[J]. Ann Surg Oncol,2017,24(4):1021-1028.

[20] DASKALAKI D,GONZALEZ-HEREDIA R,BROWN M,et al.Financial impact of the robotic approach in liver surgery:A comparative study of clinical outcomes and costs between the robotic and open technique in a single institution[J]. J Laparoendosc Adv Surg Tech A,2017,27(4):375-382.

[21] MOREL P,JUNG M,CORNATEANU S,et al. Robotic versus open liver resections:A case-matched comparison[J]. Int J Med Robot,2017.[Online ahead of print]

[22] SUGIMOTO M,TANAKA K,MATSUOKA Y,et al. da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel Gel Port access[J]. J Hepatobiliary Pancreat Sci,2011,18(4):493-498.

[23] TROISI RI,PEGORARO F,GIGLIO MC,et al. Robotic approach to the liver:Open surgery in a closed abdomen or laparoscopic surgery with technical constraints?[J]. Surg Oncol,2020,33:239-248.

[24] HU M,LIU Y,LI C,et al. Robotic versus laparoscopic liver resection in complex cases of left lateral sectionectomy[J]. Int J Surg,2019,67:54-60.

[25] ANVARI M,BIRCH DW,BAMEHRIZ F,et al. Robotic-assisted laparoscopic colorectal surgery[J]. Surg Laparosc Endosc Percutan Tech,2004,14(6):311-315.

[26] HANLY EJ,TALAMINI MA. Robotic abdominal surgery[J].Am J Surg,2004,188:19-26.

[27] MONTALTI R,BERARDI G,PATRITI A,et al. Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis[J]. World J Gastroenterol,2015,21(27):8441-8451.

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