机器人与传统腹腔镜远端胃癌根治术近期疗效对比的Meta分析

doi:10.3877/cma.j.issn.1674-0793.2021.03.017

目的

通过Meta分析的方法比较机器人远端胃癌根治术（远端胃大部切除术，RDG）与传统腹腔镜远端胃癌根治术（LDG）之间的近期疗效。

方法

检索包括EMBASE、Pubmed、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普、万方数据库有关RDG与LDG优劣比较的研究，检索时间为建库至2020年10月。NOS评分系统评价文献质量。采用Review Manager 5.3软件进行统计分析。

结果

最终纳入符合标准的相关文献14篇共2 456例患者，其中RDG组852例（34.69%），LDG组1 604例（65.31%）。与LDG组相比，RDG组手术时间长（WMD=-22.59，95% CI：-25.55~ -19.62，P<0.001），术中失血量少（WMD=34.29，95% CI：20.71~47.87，P<0.001），术后首次进食时间提前（WMD=0.33，95% CI：0.13~0.54，P=0.002），住院时间缩短（WMD=0.88，95% CI：0.05~1.71，P=0.04）。在术后首次排气时间、淋巴结清扫数目和总并发症发生率，以及腹部切口愈合不良、术后感染、术后腹腔出血、肠梗阻、肠漏等5种常见并发症方面，两组差异无统计学意义。

结论

RDG可以减少术中失血量，缩短患者术后首次进食时间和住院时间，但是对于缩短手术时间、术后首次排气时间、淋巴结清扫数目和总并发症发生率方面无明显优势。

关键词: 胃切除术, 机器人, 腹腔镜, Meta分析

Objective

To compare the short-term efficacy of robotic distal gastrectomy (RDG) and traditional laparoscopic distal gastrectomy (LDG) by Meta-analysis.

Methods

A literature search was performed including EMBASE, Pubmed, Cochrane Library, CNKI, CBM, VIP and Wanfang databases. The retrieval time was from the establishment of the database to October 2020. NOS scoring system was used to evaluate literature quality. Statistical analysis was performed using Review Manager 5.3 software.

Results

A total of 2 456 patients with 14 relevant literatures met the standards, including 852 patients (34.69%) in RDG group and 1 604 patients (65.31%) in LDG group. Compared with LDG group, RDG group had longer operation time (WMD=-22.59, 95% CI: -25.55, -19.62; P<0.001), less intraoperative blood loss (WMD=34.29, 95% CI: 20.71, 47.87; P<0.001), earlier postoperative first feeding time (WMD=0.33, 95% CI: 0.13, 0.54; P=0.002), and shorter hospital stay (WMD=0.88, 95% CI: 0.05, 1.71; P=0.04). There were no statistical differences in the postoperative first exhaust time, the number of lymph node dissection and the incidence of total complications, as well as in the following common postoperative complications, such as poor healing of abdominal incision, infection, intra-abdominal hemorrhage, intestinal obstruction and intestinal leakage between the two groups.

Conclusions

RDG for distal gastric cancer can reduce intraoperative blood loss, shorten the first postoperative feeding time and the hospital stay. However, it has no obvious advantages in terms of shortening the operation time, the postoperative first exhaust time, the number of lymph node dissection and the incidence of total complications.

Key words: Gastrectomy, Robotics, Laparoscopes, Meta-analysis

表1 纳入文献基本特征及质量评价

第一作者及发表年	国家	研究类型	研究期限(年)	分组(例)		性别(例,男/女)		体质指数(kg/m²)		TNM分期	NOS(分)
第一作者及发表年	国家	研究类型	研究期限(年)	LDG	DRG	LDG	RDG	LDG	RDG	TNM分期	NOS(分)
彭鸿2018^[6]	中国	回顾	2015—2017	120	120	82/38	78/42	24.45±3.41	24.37±3.00	Ⅰ、Ⅱ、Ⅲ	6
李松岩2018^[7]	中国	前瞻	2015—2017	56	50	39/17	35/15	24.6±2.4	24.3±2.1	T2、T3、T4a	7
Hong 2016^[8]	韩国	回顾	2008—2015	232	232	156/76	154/78	23.8±3.0	23.8±3.3	Ⅰ、Ⅱ、Ⅲ	7
Cianchi 2016^[9]	意大利	前瞻	2008—2015	41	30	19/22	14/16	26(23~30)	27(23~38)	Ⅰ、Ⅱ、Ⅲ	7
Kim 2016^[10]	韩国	前瞻	2009—2011	288	87	170/118	46/41	24±4.3	24.1±3.4	Ⅰ、Ⅱ、Ⅲ	6
Lee 2015^[11]	韩国	回顾	2003—2010	267	133	154/113	85/48	23.7±2.8	23.2±2.7	Ⅰ、Ⅱ、Ⅲ	7
Seo 2015^[12]	韩国	回顾	2004—2009	40	40	20/20	19/21	23.8±1.9	23.6±2.1	Ⅰ、Ⅱ、Ⅲ	5
Noshiro 2014^[13]	日本	前瞻	2010—2012	160	21	102/58	14/7	21.8±2.8	22.8±3.1	Ⅰ、Ⅱ、Ⅲ、Ⅳ	6
赵坤2013^[14]	中国	回顾	2012.1—2012.5	30	30	23/7	22/8	23.9±1.8	23.6±1.6	Ⅰ、Ⅱ、Ⅲ、Ⅳ	7
Uyama 2012^[15]	日本	前瞻	2009—2010	225	25	156/69	14/11	22.0±3.1	22.6±3.1	cT1	8
Eom 2012^[16]	韩国	回顾	2009—2010	62	30	41/21	21/9	24.1	24.2	Ⅰ、Ⅱ、Ⅲ、Ⅳ	6
Pugliese 2010^[17]	意大利	回顾	2000—2009	52	18	未提及	未提及	未提及	未提及	Ⅰ、Ⅱ、Ⅲ	5
Kim 2010^[18]	韩国	回顾	2007—2008	11	16	10/1	10/6	21.3±3.4	25.3±2.5	Ⅰ、Ⅱ、Ⅲ	5
Song 2009^[19]	韩国	回顾	2005—2006	20	20	13/7	8/12	22.4±2.1	23.4±2.1	Ⅰ、Ⅱ	6

表1 纳入文献基本特征及质量评价

第一作者及发表年	国家	研究类型	研究期限(年)	分组(例)		性别(例,男/女)		体质指数(kg/m²)		TNM分期	NOS(分)
第一作者及发表年	国家	研究类型	研究期限(年)	LDG	DRG	LDG	RDG	LDG	RDG	TNM分期	NOS(分)
彭鸿2018^[6]	中国	回顾	2015—2017	120	120	82/38	78/42	24.45±3.41	24.37±3.00	Ⅰ、Ⅱ、Ⅲ	6
李松岩2018^[7]	中国	前瞻	2015—2017	56	50	39/17	35/15	24.6±2.4	24.3±2.1	T2、T3、T4a	7
Hong 2016^[8]	韩国	回顾	2008—2015	232	232	156/76	154/78	23.8±3.0	23.8±3.3	Ⅰ、Ⅱ、Ⅲ	7
Cianchi 2016^[9]	意大利	前瞻	2008—2015	41	30	19/22	14/16	26(23~30)	27(23~38)	Ⅰ、Ⅱ、Ⅲ	7
Kim 2016^[10]	韩国	前瞻	2009—2011	288	87	170/118	46/41	24±4.3	24.1±3.4	Ⅰ、Ⅱ、Ⅲ	6
Lee 2015^[11]	韩国	回顾	2003—2010	267	133	154/113	85/48	23.7±2.8	23.2±2.7	Ⅰ、Ⅱ、Ⅲ	7
Seo 2015^[12]	韩国	回顾	2004—2009	40	40	20/20	19/21	23.8±1.9	23.6±2.1	Ⅰ、Ⅱ、Ⅲ	5
Noshiro 2014^[13]	日本	前瞻	2010—2012	160	21	102/58	14/7	21.8±2.8	22.8±3.1	Ⅰ、Ⅱ、Ⅲ、Ⅳ	6
赵坤2013^[14]	中国	回顾	2012.1—2012.5	30	30	23/7	22/8	23.9±1.8	23.6±1.6	Ⅰ、Ⅱ、Ⅲ、Ⅳ	7
Uyama 2012^[15]	日本	前瞻	2009—2010	225	25	156/69	14/11	22.0±3.1	22.6±3.1	cT1	8
Eom 2012^[16]	韩国	回顾	2009—2010	62	30	41/21	21/9	24.1	24.2	Ⅰ、Ⅱ、Ⅲ、Ⅳ	6
Pugliese 2010^[17]	意大利	回顾	2000—2009	52	18	未提及	未提及	未提及	未提及	Ⅰ、Ⅱ、Ⅲ	5
Kim 2010^[18]	韩国	回顾	2007—2008	11	16	10/1	10/6	21.3±3.4	25.3±2.5	Ⅰ、Ⅱ、Ⅲ	5
Song 2009^[19]	韩国	回顾	2005—2006	20	20	13/7	8/12	22.4±2.1	23.4±2.1	Ⅰ、Ⅱ	6

图1 机器人与腹腔镜远端胃癌根治术手术时间的Meta分析结果

图2 机器人与腹腔镜远端胃癌根治术中失血量的Meta分析结果

图3 机器人与腹腔镜远端胃癌根治术后首次进食时间的Meta分析结果

图4 机器人与腹腔镜远端胃癌根治术后住院时间的Meta分析结果

图5 机器人与腹腔镜远端胃癌根治术后首次排气时间的Meta分析结果

图6 机器人与腹腔镜远端胃癌根治术淋巴结清扫数目的Meta分析结果

图7 机器人与腹腔镜远端胃癌根治术后总并发症的Meta分析结果

图8 术后总并发症发生率的漏斗图

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Comparison of short-term efficacy between robotic and traditional laparoscopic rectal gastrectomy for distal gastric cancer: A Meta-analysis

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Comparison of short-term efficacy between robotic and traditional laparoscopic rectal gastrectomy for distal gastric cancer: A Meta-analysis