达芬奇机器人与传统腹腔镜胰十二指肠切除术近期疗效及安全性比较的Meta分析

代鑫; 刘汉林; 王强; 舒鹏; 程龙; 汪涛

doi:10.3969/j.issn.1001-5256.2022.05.025

达芬奇机器人与传统腹腔镜胰十二指肠切除术近期疗效及安全性比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2022.05.025

代鑫¹,
刘汉林²,
王强³,
舒鹏²,
程龙¹,
汪涛^1, , ,

1.
中国人民解放军西部战区总医院普通外科，成都 610083
2.
西南医科大学临床医学院，四川泸州 646000
3.
川北医学院临床医学系，四川南充 637000

基金项目:

四川省青年科技基金项目 (2016JQ0023)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：代鑫、刘汉林负责资料分析，撰写论文；王强、舒鹏参与收集数据，修改论文；程龙负责拟定写作思路及数据分析；汪涛负责课题设计，指导撰写文章并最后定稿。

详细信息

通信作者:
汪涛, watopo@163.com

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出版历程
- 收稿日期: 2021-09-13
- 录用日期: 2021-10-26
- 出版日期: 2022-05-20

Short-term efficacy and safety of Da Vinci robotic pancreaticoduodenectomy versus traditional laparoscopic pancreaticoduodenectomy: A meta-analysis

1.
Department of General Surgery, The General Hospital of Western Theater Command, Chengdu 610083, China
2.
Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China
3.
Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China

Research funding:

Project of Sichuan Youth Science and Technology Fund (2016JQ0023)

More Information

Corresponding author: WANG Tao, watopo@163.com(ORCID: 0000-0002-0005-0994)

摘要

摘要: 目的本研究旨在系统评价机器人手术系统与传统腹腔镜手术在胰十二指肠切除术中应用的近期疗效与安全性，为临床研究与实践提供参考。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普等中英文期刊服务平台，纳入所有对比机器人辅助腹腔镜和传统腹腔镜应用于胰十二指肠切除术临床疗效的队列研究。按照Cochrane系统评价纳入文献的质量，使用Stata 15.1软件对提取的相关结局指标进行Meta分析。结果最终纳入12篇合格的队列研究，共计1630例患者，RPD(机器人胰十二指肠切除术)组患者683例，LPD(腹腔镜胰十二指肠切除术)组患者947例。Meta分析结果显示：RPD组与LPD组患者术后出血率(OR=0.66, 95%CI: 0.48~0.91)、中转开腹率(OR=0.41, 95%CI: 0.30~0.56)、预估手术出血量(WMD=-0.77, 95%CI: -1.33~-0.22)、术后住院时间(WMD=-0.45, 95%CI: -0.80~-0.11)比较，差异均具有统计学意义(P值均＜0.05)。发表国家这一因素可能是术后总体并发症发生率亚组间异质性的来源之一(P＜0.05)。结论达芬奇机器人手术系统相较于传统LPD，可降低术后出血率、术中出血量、中转开腹率，缩短术后住院时间，且不增加手术时间和术后总体并发症发生率，两种手术方式均同样安全可行。
- 胰十二指肠切除术 /
- 机器人手术 /
- 腹腔镜 /
- Meta分析(主题)
Abstract: Objective To systematically evaluate the short-term efficacy and safety of robotic pancreaticoduodenectomy (RPD) versus traditional laparoscopic pancreaticoduodenectomy (LPD), and to provide a reference for clinical research and practice. Methods Chinese and English databases such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP were searched to include the cohort studies comparing the clinical efficacy of robot-assisted laparoscopy and traditional laparoscopy in pancreaticoduodenectomy. The quality of included articles was evaluated based on Cochrane systematic review, and Stata15.1 software was used to perform a meta-analysis of related outcome measures extracted. Results A total of 12 cohort studies were included, with 1630 patients in total, and there were 683 patients in the RPD group and 947 patients in the LPD group. The meta-analysis showed that there were significant differences between the RPD group and the LPD group in postoperative bleeding rate (odds ratio [OR]=0.66, 95% confidence interval [CI]: 0.48-0.91, P < 0.05), rate of conversion to laparotomy (OR=0.41, 95%CI: 0.30-0.56, P < 0.05), estimated intraoperative blood loss (weighted mean difference [WMD]=-0.77, 95%CI: -1.33 to -0.22, P < 0.05), and length of postoperative hospital stay (WMD=-0.45, 95%CI: -0.80 to -0.11, P < 0.05). Country of publication might be one of the sources of heterogeneity in the incidence rate of postoperative complications between subgroups (P < 0.05). Conclusion Compared with traditional LPD, da Vinci RPD can reduce postoperative bleeding rate, intraoperative blood loss and rate of conversion to laparotomy and shorten postoperative hospital stay, and meanwhile, it does not increase the operation time and the incidence rate of postoperative complications. Both surgical procedures are safe and feasible.
- Pancreaticoduodenectomy /
- Robotic Surgical Procedures /
- Laparoscopes /
- Meta-Analysis as Topic

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图 1 文献筛选流程

Figure 1. Document screening flow chart

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图 2 RPD组与LPD组术后总体并发症发生率的森林图

Figure 2. Forest map of overall incidence of postoperative complications in RPD group and LPD group

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图 3 RPD组与LPD组术后胰漏的森林图

Figure 3. Forest map of postoperative pancreatic leakage in RPD group and LPD group

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图 4 RPD组与LPD组术后胃瘫的森林图

Figure 4. Forest map of postoperative gastroparesis in RPD group and LPD group

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图 5 RPD组与LPD组术后胆漏的森林图

Figure 5. Forest map of postoperative bile leakage in RPD group and LPD group

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图 6 RPD组与LPD组术后出血率的森林图

Figure 6. Forest map of postoperative bleeding rate in RPD group and LPD group

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图 7 RPD组与LPD组中转开腹率的森林图

Figure 7. Forest map of conversion to laparotomy in RPD group and LPD group

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图 8 RPD组与LPD组脾脏保留率的森林图

Figure 8. Forest map of spleen retention rate in RPD group and LPD group

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图 9 RPD组与LPD组中淋巴结清扫的森林图

Figure 9. Forest map of lymph node dissection in RPD group and LPD group

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图 10 RPD组与LPD组手术时间的森林图

Figure 10. Forest map of operation time in RPD group and LPD group

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图 11 RPD组与LPD组手术出血量的森林图

Figure 11. Forest map of operative bleeding volume in RPD group and LPD group

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图 12 RPD组与LPD组术后住院时间森林图

Figure 12. Forest map of postoperative hospital stay in RPD group and LPD group

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图 13 发表偏倚

注：a, 术后总体并发症; b, 术后胰漏；c, 手术时间；d, 术后住院时间。

Figure 13. Publication bias

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图 14 敏感性分析结果

注：a, 脾脏保留率；b, 淋巴结清扫数；c, 手术预估出血量；d, 手术时间; e, 术后住院时间。

Figure 14. Sensitivity analysis results

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表 1 纳入文献基本特征

Table 1. Including the basic characteristics of the literature

作者	年份	国家	样本量	研究类型	RPD组(例)	LPD组(例)
Daouadi^[14]	2013	美国	124	回顾性队列研究	30	94
Duran^[4]	2014	西班牙	34	回顾性队列研究	16	18
Chen^[5]	2015	中国	119	回顾性队列研究	69	50
Lai^[6]	2015	中国	35	回顾性队列研究	17	18
Liu^[7]	2017	中国	52	回顾性队列研究	27	25
Nassour^[8]	2017	美国	428	回顾性队列研究	193	235
Zhang^[9]	2018	中国	40	回顾性队列研究	20	20
Zimmerman^[10]	2019	美国	491	回顾性队列研究	211	280
Tu^[11]	2020	中国	61	回顾性队列研究	24	37
Butturini^[12]	2014	意大利	43	前瞻性队列研究	22	21
Lee^[13]	2015	美国	168	前瞻性队列研究	37	131
Waters^[15]	2010	美国	35	前瞻性队列研究	17	18

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表 2 纳入文献质量评价

Table 2. Including literature quality evaluation

作者	年份	国家	对象的选择				可比性	结局评估			得分
作者	年份	国家	1	2	3	4	5	6	7	8	得分
Daouadi^[14]	2013	美国	★	★	★	★	★	★	★	★	8
Duran^[4]	2014	西班牙	★	★	★	★	★	★	★	_	7
Chen^[5]	2015	中国	★	★	★	★	★	★	★	★	8
Lai^[6]	2015	中国	★	★	★	★	★	★	★	_	7
Liu^[7]	2017	中国	★	★	★	★	★	★	★	_	7
Nassour^[8]	2017	美国	★	★	★	★	★	★	★	★	8
Zhang^[9]	2018	中国	★	★	★	★	★	★	★	★	8
Zimmerman^[10]	2019	美国	★	★	★	★	★	★	★	★	8
Tu^[11]	2020	中国	★	★	★	★	★	★	★	★	8
Butturini^[12]	2014	意大利	★	★	★	★	★	★	★	★	8
Lee^[13]	2015	美国	★	★	★	★	★	★	★	★	8
Waters^[15]	2010	美国	★	★	★	★	★	★	★	★	8

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表 3 亚组分析

Table 3. Subgroup analysis

纳入指标	中国		其他国家		P值
纳入指标	合并效应值	95%CI	合并效应值	95%CI	P值
中转开腹率	0.16	0.02~1.25	0.14	0.31~0.58	0.10
术后总体并发症发生率	0.55	0.31~0.97	1.24	0.97~1.57	0.01
术后胰漏	0.74	0.42~1.30	1.13	0.85~1.51	0.18
术后出血率	0.37	0.14~0.98	0.71	0.51~1.00	0.21
术后胃瘫	0.46	0.08~2.80	0.82	0.57~1.16	0.54
保脾率	3.52	1.23~10.05	1.49	0.42~5.29	0.31
手术时间	0.38	-0.85~1.62	0.19	-0.19~0.58	0.77
术后住院时间	-0.77	-1.38~-0.16	-0.12	-0.39~0.16	0.06
预估手术出血量	-0.99	-1.61~-0.36	-0.2	-0.72~0.32	0.06
淋巴结清扫	1.27	-1.07~3.60	0.43	-0.30~1.16	0.50
注：P为亚组间的异质性。

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