机器人辅助与传统腹腔镜胰体尾切除术治疗胰腺恶性肿瘤疗效比较的Meta分析
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作者单位:

1.兰州大学第一临床医学院,甘肃 兰州 730000;2.甘肃省人民医院 普外临床医学中心,甘肃 兰州 730000;3.甘肃中医药大学第一临床医学院,甘肃 兰州 730000;4.兰州大学循证医学中心,甘肃 兰州 730000;5.甘肃省循证医学与临床转化重点实验室,甘肃 兰州 730000

作者简介:

杨雯雯,兰州大学第一临床医学院硕士研究生,主要从事肝胆胰疾病的临床和基础方面的研究(
田宏伟为共同一作)。

基金项目:

中国医学科学院中央级公益性科研院所基本科研业务费专项基金资助项目(2019PT320005);甘肃省自然科学基金资助项目(20JR10RA403);甘肃省外科肿瘤分子诊断与精准治疗重点实验室开放基金资助项目(2019GSZDSYS06)。


Meta-analysis of efficacy of robotic-assisted versus conventional laparoscopic distal pancreatectomy for malignant pancreatic diseases
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Affiliation:

1.The First Clinical Medical College, Lanzhou University, Lanzhou 730000, China;2.General Surgery Clinical Medicine Center, Gansu Provincial People’s Hospital, Lanzhou 730000, China;3.The First Clinical Medical College, Gansu University of Chinese Medical, Lanzhou 730000, China;4.Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, China;5.Key Laboratory of Evidence-Based Medicine and Clinical Transformation in Gansu Province, Lanzhou 730000, China

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    摘要:

    背景与目的 目前手术切除依旧是胰腺恶性肿瘤的首选治疗方法,但采用机器人胰体尾切除术(RDP)还是腹腔镜胰体尾切除术(LDP)争议很大。本研究通过Meta分析方法评价RDP与LDP在治疗胰腺恶性肿瘤患者的有效性与安全性,以获得循证学证据为临床决策提供依据。方法 计算机检索多个国内外数据库,收集比较关于RDP与LDP治疗胰腺恶性肿瘤临床疗效的文献,检索时限均为建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果 最终纳入15篇文献,共2 940例患者,其中997例行RDP,1 943例行LDP。Meta分析结果显示:与LDP比较,RDP的保脾率提高(OR=2.31,95% CI=1.37~3.90,P=0.002),术中中转开腹率(OR=0.36,95% CI=0.24~0.52,P?0.000 01)、90 d再手术率(OR=0.46,95% CI=0.24~0.89,P=0.02)和30 d病死率(OR=0.18,95% CI=0.06~0.53,P=0.002)均降低,手术时间延长(MD=-40.09,95% CI=-77.64~-2.54,P=0.04),淋巴结清扫数量增多(MD=2.06,95% CI=0.65~3.47,P=0.004);而在术中出血量、总并发症率、伤口感染、胰瘘、住院时间、90 d再入院率等差异均无统计学意义(均P?0.05)。结论 当前的证据表明,与LDP比较,RDP能提高保脾率和淋巴结清扫数目,降低中转开腹率、90 d再手术率及30 d病死率。这表明RDP与LDP在胰腺恶性肿瘤治疗上有着相似的安全性和有效性。受纳入研究数量和质量限制,上述结论还需多中心、大样本随机对照试验予以验证。

    Abstract:

    Background and Aims Surgical resection is still the preferred treatment for malignant pancreatic diseases at present. However, the use of robotic-assisted distal pancreatectomy (RDP) or laparoscopic distal pancreatectomy (LDP) is still controversial. This study was conducted to evaluate the efficacy and safety of using RDP and LDP in the treatment of patients with malignant pancreatic diseases by Meta-analysis, so as to obtain evidence-based information to provide basis for clinical decision-making.Methods The studies comparing the clinical efficacy of RDP versus LDP for malignant pancreatic diseases were collected by a computer-based search in several national and international databases from their inception to March 2021. After literature screening, data extraction and bias risk evaluation by two reviewers independently, Meta-analysis was performed using RevMan 5.4 software.Results Fifteen studies were finally included, involving 2 940 patients, of whom, 997 cases underwent RDP and 1 943 cases underwent LDP. The results of Meta-analysis showed that in RDP group compared with LDP group, the spleen preservation rate (OR=2.31, 95% CI=1.37-3.90, P=0.002) was increased, the intraoperative conversion rate (OR=0.36, 95% CI=0.24-0.52, P?0.000 01), 90-d reoperation rate (OR=0.46, 95% CI=0.24-0.89, P=0.02), and 30-d mortality (OR=0.18, 95% CI=0.06-0.53, P=0.002)were reduced, the operative time was prolonged (MD=-40.09, 95% CI=-77.64-2.54, P=0.04), and the number of lymph nodes harvested (MD=2.06, 95% CI=0.65-3.47, P=0.004) was increased. However, no significant differences were found in intraoperative blood loss, total complication rate, surgical site infection, pancreatic fistula, length of hospital stay, and 90-d readmission rate (all P>0.05).Conclusion The current evidence indicates that RDP may increase the spleen preservation rate and the number of lymph nodes harvested, and reduce open conversion rate, 90-d reoperation rate, and 30-d mortality compared with LDP. These results indicate that RDP and LDP have similar safety and efficacy in the treatment of malignant pancreatic diseases. Limited by the quality and quantity of the included studies, the above conclusions need to be verified by more multicenter randomized controlled trials with large sample size.

    表 1 纳入研究的基本特征Table 1 General characteristics of the included studies
    表 4 亚组分析Table 4 Subgroup analysis
    表 3 其他结局指标的Meta分析结果Table 3 Meta-analysis results of other outcome variables
    表 2 纳入研究的基本特征(续)Table 2 General characteristics of the included studies (continued)
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杨雯雯,田宏伟,宋绍明,雷彩宁,龚世怡,景武堂,杨克虎,郭天康.机器人辅助与传统腹腔镜胰体尾切除术治疗胰腺恶性肿瘤疗效比较的Meta分析[J].中国普通外科杂志,2021,30(9):1047-1058.
DOI:10.7659/j. issn.1005-6947.2021.09.008

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  • 收稿日期:2021-05-22
  • 最后修改日期:2021-08-24
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  • 在线发布日期: 2021-10-09