机器人辅助与腹腔镜肝切除治疗肝脏肿瘤疗效与安全性的Meta分析
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遵义医科大学附属医院 肝胆胰外科,贵州 遵义 563000

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郭毅,遵义医科大学附属医院主治医师,主要从事肝胆疾病方面的研究。

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国家自然科学基金资助项目(81660688)。


Robot-assisted laparoscopic versus laparoscopic hepatectomy for liver tumors: a Meta-analysis
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Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China

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    摘要:

    背景与目的 机器人辅助腹腔镜肝切除(RALH)能克服传统腹腔镜肝切除(LH)的一些技术限制,并提高手术的灵活性和精确度,但以往的Meta分析结果对于RALH是否真正优于LH仍有争议。因此,本研究通过新的Meta分析再评价RALH治疗肝脏肿瘤的效果及安全性。方法 检索多个国内外数据库,收集比较RALH与LH治疗肝脏肿瘤的所有中英文文献,检索时间从2000年1月—2021年2月,对纳入文献进行筛选和质量评价后,使用RevMan5.3软件进行Meta分析。结果 最终纳入30篇文献,包括3 480例患者,其中RALH组1 332例,LH组2 148例。Meta分析结果显示,与LH组比较,RALH组的手术时间更长(MD=45.66,95% CI=26.60~64.72,P<0.000 01),术中中转率较低(RR=0.66,95% CI=0.50~0.86,P=0.002),术中输血率较高(RR=1.88,95% CI=1.30~2.71,P=0.000 7),总费用较高(MD=0.51,95% CI=0.44~0.57,P<0.000 01)。但在术中出血量、肝门阻断率、术后并发症发生率、术后住院时间、病死率、R0及R1切除率方面,两者差异均无统计学意义(均P>0.05)。结论 基于目前证据表明,RALH是安全且有效的,尽管其具有更高的总费用、更长的手术时间,但在其余主要结局指标方面与LH几乎无差异,提示两者具有相似的手术疗效及安全性,未来仍需更多临床随机对照试验来予以验证。

    Abstract:

    Background and Aims The robot-assisted laparoscopic hepatectomy (RALH) can overcome some technical limitations in traditional laparoscopic hepatectomy (LH), and also improve the operating flexibility and accuracy. However, results of previous Meta-analysis created controversial consequences on whether RALH is indeed superior to LH. Therefore, this study was performed to reevaluate the efficacy and safety of RALH for the treatment of liver tumors by a new Meta-analysis.Methods Both Chinese and English literature of all studies comparing RALH and LH in the treatment of liver tumors were collected by searching several national and international databases. The retrieval time was set from January 2000 to February 2021. After literature screening and quality assessment, Meta-analysis was performed by using the RevMan5.3 software.Results A total of 30 studies were included, involving 3 480 patients, with 1 332 cases in RALH group and 2 148 cases in LH group. Results of Meta-analysis showed that in RALH group compared with LH group, the operative time was longer (MD=45.66, 95% CI=26.60-64.72, P<0.000 01), intraoperative conversion rate was lower (RR=0.66, 95% CI=0.50-0.86, P=0.002), intraoperative blood transfusion rate was higher (RR=1.88, 95% CI=1.30-2.71, P=0.000 7) and total cost was higher (MD=0.51, 95% CI=0.44-0.57, P<0.000 01). However, there were no significant differences in terms of the intraoperative blood loss, hepatic portal occlusion rate, incidence of postoperative complications, length of postoperative hospital stay, mortality, and the R0 and R1 resection rates (all P>0.05).Conclusion Based on the current evidence, RALH is safe and effective. Although it has higher total cost and longer operative duration, there is almost no difference with LH in other main outcome indicators, suggesting that they have similar surgical efficacy and safety, and more clinical randomized controlled trials are still needed for verification in the future.

    表 4 纳入研究NOS量表质量评分(续)Table 4 The quality score evaluated by NOS of the included studies (continued)
    图1 文献筛选流程图Fig.1 Literature screening process
    图2 两组手术时间比较的Meta分析Fig.2 Meta-analysis comparing the operative times between the two groups
    图3 两组术中出血量比较的Meta分析Fig.3 Meta-analysis comparing the intraoperative blood loss between the two groups
    图4 两组术中输血率比较的Meta分析Fig.4 Meta-analysis comparing the intraoperative blood transfusion rates between the two groups
    图5 两组中转率比较的Meta分析Fig.5 Meta-analysis comparing the conversion rate between the two groups
    图6 两组肝门阻断率比较的Meta分析Fig.6 Meta-analysis comparing the hepatic portal occlusion rates between the two groups
    图7 两组术后并发症比较的Meta分析Fig.7 Meta-analysis comparing the postoperative complications between the two groups
    图8 两组术后住院时间比较的Meta分析Fig.8 Meta-analysis comparing the lengths of postoperative hospital stay between the two groups
    图9 两组病死率比较的Meta分析Fig.9 Meta-analysis comparing the mortality rates between the two groups
    图10 两组总费用比较的Meta分析Fig.10 Meta-analysis comparing the total costs between the two groups
    图11 两组R0切除率比较的Meta分析Fig.11 Meta-analysis comparing the R0 resection rates between the two groups
    图12 两组R1切除率比较的Meta分析Fig.12 Meta-analysis comparing the R1 resection rates between the two groups
    图13 发表偏倚分析Fig.13 Analysis of publication bias
    表 1 纳入文献的基本特征Table 1 The basic characteristics of included studies
    表 2 纳入文献的基本特征(续)Table 2 The basic characteristics of included studies (continued)
    表 3 纳入研究NOS量表质量评分Table 3 The quality score evaluated by NOS of the included studies
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郭毅,王磊,刘康伟,李鑫垚,彭慈军.机器人辅助与腹腔镜肝切除治疗肝脏肿瘤疗效与安全性的Meta分析[J].中国普通外科杂志,2022,31(1):8-21.
DOI:10.7659/j. issn.1005-6947.2022.01.002

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  • 收稿日期:2021-08-04
  • 最后修改日期:2021-12-10
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  • 在线发布日期: 2022-01-27