机器人辅助腹腔镜与传统腹腔镜行子宫全切手术安全性和有效性的系统评价

发布时间：2018-02-26 22:40

本文关键词： 机器人腹腔镜子宫切除 Meta分析　出处：《重庆医科大学学报》2015年10期 　论文类型：期刊论文

【摘要】：目的:比较机器人辅助腹腔镜与传统腹腔镜行子宫全切手术的安全性和有效性。方法:检索Pub Med、Cochrane Library、EMBASE、Medline、万方、知网、维普等数据库,查找机器人辅助腹腔镜与传统腹腔镜行子宫全切手术的随机对照试验(randomized controlled trials,RCTs)和非随机对照试验(non-randomized controlled trials,NRCTs)。按纳入排除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辅助腹腔镜组和传统腹腔镜组,提取数据后用Rev Man5.3软件进行Meta分析,比较2种手术方式行子宫全切术的安全性及有效性。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)及可信区间(95%CI)表示。结果:共纳入5个RCTS及26个NRCTs,共计需行子宫全切术患者4 235例,其中机器人辅助腹腔镜组1 870例,传统腹腔镜组2 365例。Meta分析结果显示:与传统腹腔镜组比较,机器人辅助腹腔镜组的围手术期并发症发生率低(OR=0.71,95%CI=0.57~0.89,Z=2.97,P=0.003)、住院时间短(WMD=-0.42,95%CI=-0.65~-0.20,Z=3.67,P=0.000 2)、术中出血少(WMD=-81.04,95%CI=-104.50~-57.58,Z=6.77,P=0.000)、中转开腹率低(OR=0.38,95%CI=0.25~0.58,Z=4.60,P=0.000);2组患者手术时间(WMD=15.38,95%CI=-4.48~35.23,Z=1.52,P=0.130)、淋巴结清除数目[盆腔淋巴结(WMD=-1.09,95%CI=-2.61~0.43,Z=1.40,P=0.160);血管旁淋巴结(WMD=-0.19,95%CI=-2.93~2.56,Z=0.13,P=0.890)]比较,差异无统计学意义。亚组分析显示:对于子宫重量小于200 g的患者,机器人辅助腹腔镜组术中出血更少(WMD=-88.78,95%CI=-98.03~-79.52,Z=18.80,P=0.000),差异有统计学意义。结论:与传统腹腔镜相比,机器人辅助腹腔镜手术行子宫全切术时围手术期并发症发生率低、住院时间短、术中出血少(尤其对于子宫重量较小的患者)、中转开腹率低,但手术时间及淋巴结清除数目无差异。不过,考虑到原始研究质量不高以及明显的异质性,本研究结论论证强度有限。
[Abstract]:Objective: to compare the safety and efficacy of robotic assisted laparoscopy and traditional laparoscopic hysterectomy. Methods: Pub MedCochrane Library EMBASE Medline, Wanfang, Chiwang, Weip and other databases were searched. To find out the randomized controlled trialsl trials (randomized controlled trialsl rcts) and non-randomized controlled trialsn (NRCTs) performed by robot-assisted laparoscopy and traditional laparoscopic hysterectomy, and to screen and evaluate the quality according to the exclusion criteria. Patients included in the literature were divided into robot-assisted laparoscopy group and traditional laparoscopic group. The data were extracted and analyzed by Rev Man5.3 software. To compare the safety and efficacy of total hysterectomy with two kinds of surgical methods. The two classification variables were expressed as odds ratio (OR) and confidence interval (95% CI). The continuous variables were expressed by weighted mean difference (WMD) and confidence interval (CI). Results: totally 5 RCTS and 26 NRCTs were included. A total of 4 235 patients underwent total hysterectomy, including 1 870 cases in the robot-assisted laparoscopic group. Meta-analysis of 2 365 cases in the traditional laparoscopic group showed that: compared with the traditional laparoscopic group, The incidence of perioperative complications in the robot-assisted laparoscopy group was low: 0.570.570.89Z2.97P0. 003, and the hospital stay was short. WMD-0.4295CI-0.65- 0.20Z3.67CI-0.0002.The intraoperative bleeding was less than WMD-895CI-104.50- 57.58Z6.7P0.000, and the rate of conversion to abdominal cavity was low. The difference was not statistically significant. Subgroup analysis showed that for patients with uterine weight less than 200 g, the intraoperative bleeding in the robot-assisted laparoscopic group was less than that in the conventional laparoscopy group. Conclusion: compared with traditional laparoscopy, the difference is statistically significant. The incidence of perioperative complications was low, the hospital stay was short, the bleeding was less during the operation (especially for the patients with lower uterine weight, the rate of conversion to laparotomy was low, especially for the patients with lower uterine weight), the incidence of perioperative complications during total hysterectomy was low, and the operative bleeding was less. But there was no difference in the operative time and the number of lymph nodes removed. However, considering the low quality and obvious heterogeneity of the original study, the conclusion of this study is limited in intensity.
【作者单位】：重庆医科大学附属第一医院肿瘤科;
【分类号】：R713.42;TP242

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