机器人辅助与腹腔镜肾部分切除术临床效果的Meta分析

发布时间：2018-03-16 16:31

本文选题：机器人辅助　切入点：腹腔镜　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景达芬奇机器人手术系统在泌尿外科已广泛应用,虽然它的优势明显,但就目前而言,机器人辅助肾部分切除术和腹腔镜肾部分切除术的临床效果和安全性仍存在一定争论。目的评价机器人辅助的肾部分切除术和腹腔镜肾部分切除术的临床效果。方法以"Robotics AND Nephrectomy"、"Robotics AND Nephrectomy AND Laparoscopy"、" Robotics AND Laparoscopy AND Nephrectomy AND Partial"、"LPN AND RPN"“机器人辅助肾部分切AND腹腔镜肾部分切除术”为关键词,在Pubmed、CNKI、维普数据库中检索截止至2013年05月31日前发表的随机对照试验,根据纳入和排除标准筛选纳入的文献,并提取所需数据,应用Review Manager5.2.5(Java6)软件进行数据处理,对机器人辅助肾部分切除术和传统腹腔镜肾部分切除术两组在估计出血量、手术时间、热缺血时间、切缘阳性、并发症及住院时间六个方面进行Meta分析。结果最终共筛选出7篇文献,均为外文文献,Meta分析中具体统计量值如下：估计失血量[I2=77%,MD=-10.01,95%CI(-62.74,42.72), Z=0.37, P=0.71];手术时间[I2=92%, MD=-4.54,95%CI(-29.04,19.96), Z=0.36, P=0.72];热缺血时间[MD=-1.47,95%CI[-2.82,-0.11] Z=2.12, P=0.03];并发症[OR=1.35,95%CI(0.67,2.74), Z=0.84, P=0.40];切缘阳性[OR=1.91,95%CI (0.50,7.29), Z=0.95, P=0.34];住院时间[MD=-0.08,95%CI(-0.37,0.22), Z=0.50, P=0.62]。其中热缺血时间的两组间差异有统计学意义,说明RPN组在热缺血时间上优于LPN组,即同LPN相比,RPN对肾脏损伤更小、可更好地保护肾功能。而估计出血量等其他各比较均无统计学意义。结论RPN与LPN两种术式的手术效果基本一致,而前者的肾热缺血时间较短,这对保护肾功能有积极的作用,同时也对临床如何选择手术方式提供了依据。
[Abstract]:Background Leonardo da Vinci robotic surgery system has been widely used in urology. Although its advantages are obvious, The clinical efficacy and safety of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy are still controversial. Objective to evaluate the clinical effects of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy. Methods "Robotics AND Nephrectomy", "Robotics AND Nephrectomy AND Laparoscopy", "Robotics AND Laparoscopy AND Nephrectomy AND Partial", "LPN AND RPN" "robot-assisted partial nephrectomy" were used as the key words. A randomized controlled trial published up to May 31st 2013 was searched in the Pubmedan CNKI database. According to the inclusion and exclusion criteria, the selected literatures were selected, and the required data were extracted, and the data were processed with Review Manager 5.2.5 Java 6 software. In the two groups, robot-assisted partial nephrectomy and traditional laparoscopic partial nephrectomy were used to estimate blood loss, operative time, warm ischemic time, positive margin. Meta analysis was carried out in six aspects of complications and hospital stay. The specific statistical values in the meta-analysis of the foreign literature are as follows: estimated blood loss [I2O77MD-10.0195 CIQ [-62.742], Z0.37, P0.71]; operative time [I2O922, MD-4.595CI-29.095CI-29.095 CI-29.0495 CI-29.0495 CI-29.0495, Z0.36, P0.72]; hot ischemic time [MD-1.4795CI [-2.82mc-0.11] Z 2.12, P0.03]; complications [OR1.3595CIA 72.74, ZJU 40.74, P0.40]; The difference between the two groups is statistically significant. The results showed that the RPN group was superior to the LPN group in the time of hot ischemia, that is, compared with the LPN group, the renal injury was less in the RPN group. Conclusion the effect of RPN and LPN is basically the same, and the time of renal ischemia is shorter in the former, which has a positive effect on the protection of renal function. At the same time, it also provides the basis for how to choose the operation mode.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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