达芬奇机器人与腹腔镜、开腹在胃癌根治术疗效对比的系统评价

发布时间：2018-03-17 17:45

本文选题：胃癌根治术　切入点：达芬奇机器人　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对已发表的临床研究进行Meta分析,系统性评价达芬奇手术机器人与腹腔镜和开腹手术在治疗胃癌方面的近期临床疗效和安全性。方法:检索the Cochrane Library、PubMed、EMBASE、Web of Science、中国生物医学文献数据库(CBMdisc)、中国知网(CNKI)、中文科技期刊全文数据库(VIP)以及万方数据库,检索时间为2000年07月至2016年04月,语种限定为英文。纳入符合要求的临床随机对照试验(Randomized Controlled Trials,RCTs)、回顾性观察研究(Retrospective observational research,Retro)及回顾性非随机对照研究(Retrospective Non-randomized Trial,RNT),由2名研究员分别独立提取数据并进行文献质量评价,用Revman5.3和Sata12.0软件进行Meta分析。研究指标为出血量(Evaluated Blood Loss,EBL)、术后通气时间(Day of First Flatus)、术后首次进食时间(Days of eating liquid diets),收获淋巴结数量(Number of harvested lymph nodes)、术后住院天数(Length of postoperative hospital stay)及吻合口瘘、肠梗阻、肺部感染、伤口感染、死亡等并发症。结果:最终纳入14篇文献,其中回顾性研究13篇,随机对照研究1篇,共10255例胃癌患者,其中开腹组5285例,腔镜组3283例,机器人组687例。达芬奇机器人组同腹腔镜组对比,达芬奇机器人组在胃癌根治术中的出血量少于腹腔镜组[95%可信区间(CI):-21.97—-16.28],清扫淋巴结总数大于腹腔镜组[95%CI:1.03-2.31],术后通气时间短于腹腔镜组[95%CI:-0.37—-0.17],术后住院天数短于腹腔镜组[95%CI:-0.8—-0.41]。术后吻合口瘘、肠梗阻、肺部感染、伤口感染、死亡等并发症的发生率在两组之间均无统计学差异。机器人组同开腹组对比,出血量显著少于后者[95%可信区间(CI):-89.72—-68.52],术后通气时间短于开腹组[95%可信区间(CI):-0.47—-0.22],术后首次进食时间短于开腹组[95%可信区间(CI):-1.35—-1.01],术后住院天数短于开腹组[95%可信区间(CI):-1.60—-0.74]。在术后并发症中,达芬奇机器人组较腹腔镜组及开腹组发生例数无统计学差异。结论:达芬奇机器人胃癌手术相较传统腹腔镜胃癌手术与开腹胃癌而言,创伤更小,术后恢复更快,清扫淋巴结数量更多,可在今后的临床工作中推广使用。
[Abstract]:Objective: to carry out Meta analysis of published clinical studies. Methods: the clinical efficacy and safety of Leonardo da Vinci surgical robot, laparoscopy and laparotomy in the treatment of gastric cancer were systematically evaluated. Methods: the Cochrane Library PubMedus the of Science, Chinese Biomedical Literature Database, CNKI, Chinese. Full text Database of Sci-tech Journals (VIPs) and Wanfang Database, The retrieval time is from July 2000 to April 2016, The language was limited to English. The randomized Controlled trials were included in the randomized Controlled trials, retrospective observational research and retrospective non-randomized control studies. The two researchers independently extracted the data and evaluated the quality of the literature. Meta analysis was carried out with Revman5.3 and Sata12.0 software. The indexes were: blood loss, postoperative ventilation time, days of eating liquid dietsm, number of lymph nodes of harvested lymph nodeses, length of length of postoperative hospital stoma and anastomotic fistula. Results: 14 literatures were included, including 13 retrospective studies and 1 randomized controlled study. There were 10255 patients with gastric cancer, including 5285 patients in the open group and 3283 in the endoscopic group. Robot group 687 cases. Leonardo da Vinci robot group compared with laparoscopic group, The amount of bleeding in the da Vinci robot group was less than that in the laparoscopic group [95% CI: -21.97-16.28], the total number of lymph nodes dissected was larger than that in the laparoscopic group [95CI: 1.03-2.31], the postoperative ventilation time was shorter than that in the laparoscopic group [95CI: -0.37-0.17], the postoperative hospital stay was shorter than that in the laparoscope group [95CIwar-0.8-0.41]. The incidence of intestinal obstruction, lung infection, wound infection and death was not significantly different between the two groups. The amount of bleeding was significantly less than that of the latter group [95% CI: 89.72-68.52], the postoperative ventilation time was shorter than that in the open group [95% confidence interval CI: -0.47 -0.22], the first time of eating after operation was shorter than that in the open group [95% confidence interval], and the postoperative hospital stay was shorter than that in the open group [95% confidence interval CI: -1.60-0.74]. There was no significant difference in the number of cases in the da Vinci robot group compared with the laparoscopic group and the open group. Conclusion: compared with the traditional laparoscopic and open gastric cancer surgery, the da Vinci robot gastric cancer group has less trauma and faster recovery after operation. More lymph node dissection can be used in clinical work in the future.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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