摘要
目的:通过Meta分析对比机器人辅助下经自然腔道标本取出手术(Natural Orifice Specimen Extraction Surgery,NOSES)与常规机器人辅助手术治疗结直肠癌的临床疗效。方法:检索截至2021年12月公开发表的机器人辅助经自然腔道取出标本的结直肠癌根治术对比常规机器人辅助手术治疗结直肠癌的研究。根据原始文献的纳入标准、排除标准对检索文献进行相关筛选,对纳入文献进行质量评价,获得最终纳入分析的文献。提取纳入文献的相关数据,采用Rev Man5.3统计学软件进行分析。结果:最终纳入8篇文献,其中1篇随机对照研究,7篇回顾性研究,共涉及701例患者,其中行机器人辅助下经自然腔道标本取出手术(NOSES组)338例,行常规机器人辅助手术(常规机器人组)363例。Meta分析结果显示,NOSES组手术时间比常规机器人组更长(WMD=7.69,95%CI=1.89~13.50,P=0.009),差异有统计学意义。两组术中出血量相比,NOSES组术中出血量高于常规机器人组(WMD=-4.93,95%CI=-9.32~-0.53,P=0.03);两组切除的肿瘤大小比较,差异无统计学意义(WMD=-0.09,95%CI=-0.26~0.08,P=0.30);两组淋巴结清扫数目比较,差异无统计学意义(WMD=-0.32,95%CI=-0.85~0.21,P=0.24);两组术后腹腔冲洗液细菌学检测结果比较,差异无统计学意义(OR=1.42,95%CI=0.56~3.62,P=0.46)。与常规机器人组相比,NOSES组术后VAS评分更低(WMD=-1.14,95%CI=-1.55~-0.74,P<0.001),术后附加镇痛更少(OR=0.22,95%CI=0.13~0.38,P<0.001),术后血常规WBC水平更低(WMD=-0.99,95%CI=-1.44~-0.54,P<0.001),术后首次排气时间更早(WMD=-11.36,95%CI=-14.70~-8.02,P<0.001),术后首次进食时间更早(WMD=-9.13,95%CI=-11.49~-6.78,P<0.001),术后总并发症更少(OR=0.57,95%CI=0.35~0.92,P=0.02),切口感染率更低(OR=0.20,95%CI=0.06~0.83,P=0.006),差异有统计学意义。两组吻合口瘘发生率(OR=1.35,95%CI=0.58~3.14,P=0.49)、腹腔内感染发生率(OR=1.26,95%CI=0.36~4.42,P=0.72)和肠梗阻发生率(OR=0.68,95%CI=0.19~2.43,P=0.56)比较,差异无统计学意义。NOSES组术后住院时间比常规机器人组更短(WMD=-1.21,95%CI=-2.08~-0.34,P=0.006),差异有统计学意义。结论:与传统机器人辅助手术相比,机器人辅助下经自然腔道标本取出手术可以减轻术后疼痛,减小附加镇痛比例,降低机体应激反应,降低术后总并发症发生率,更快恢复胃肠道功能。
Objective:To compare the clinical efficacy of robot-assisted natural orifice specimen extraction surgery(NOSES)and conventional robot-assisted surgery in the treatment of colorectal cancer by Meta-analysis.Methods:To retrieve studies on the comparison of robot-assisted radical resection of colorectal cancer with NOSES approach and conventional robot-assisted surgery in treating colorectal cancer before December 2021.The retrieved studies were screened according to certain inclusion and exclusion criteria,and the quality of included literature was evaluated to obtain the qualified literatures for analysis.The relevant data of the included literatures were extracted,and RevMan5.3 was used for statistical analysis.Results:Finally,8 articles were included,including 1 randomized controlled study and 7 retrospective studies.701 patients were involved in the 8 studies,including 338 robot-assisted natural orifice specimen extraction surgery(NOSES group)and 363 conventional robot-assisted surgeries(conventional robotic group).The meta-analysis result showed that the operative time in the NOSES group was longer than that in the conventional robotic group(WMD=7.69,95%CI=1.89 to 13.50,P=0.009),the intraoperative blood loss of the NOSES group was higher than that of the conventional robtic group(WMD=-4.93,95%CI=-9.32 to 0.53,P=0.03),the size of resected tumors(WMD=-0.09,95%CI=-0.26 to 0.08,P=0.30),the number of lymph node dissection(WMD=-0.32,95%CI=-0.85 to 0.21,P=0.24)or the microbiological detection results on peritoneal washings after surgery(OR=1.42,95%CI=0.56 to 3.62,P=0.46)were found between the two groups.The postoperative VAS score in the NOSES group was lower than that in the conventional robotic group(WMD=-1.14,95%CI=-1.55 to-0.74,P<0.001).The postoperative added analgesia was less in the NOSES group than in the conventional robot group(OR=0.22,95%CI=0.13 to 0.38,P<0.001).The level WBC after surgery of NOSES group was lower than that in conventional robotic group(WMD=-0.99,95%CI=-1.44 to-0.54,P<0.001).The first exhaust time after surgery in the NOSES group was earlier than that in the conventional robotic group(WMD=-11.36,95%CI=-14.70 to-8.02,P<0.001).The first feeding time after surgery in the NOSES group was earlier than that in the conventional robotic group(WMD=-9.13,95%CI=-11.49 to-6.78,P<0.001).The total postoperative complications were less in the NOSES group than the conventional robotic group(OR=0.57,95%CI=0.35 to 0.92,P=0.02).The NOSES group had lower surgical sites infection rate than the conventional robotic group(OR=0.20,95%CI=0.06 to 0.83,P=0.006).There was no significant difference in the incidence of anastomotic fistula(OR=1.35,95%CI=0.58 to 3.14,P=0.49),the intraperitoneal infection(OR=1.26,95%CI=0.36 to 4.42,P=0.72),or occurrence of intestinal obstruction(OR=0.68,95%CI=0.19 to 2.43,P=0.56)between the two groups.The postoperative hospital stay in the NOSES group was shorter than that in the conventional robotic group(WMD=-1.21,95%CI=-2.08 to-0.34,P=0.006).Conclusion:Compared with the conventional robot-assisted surgery,robot-assisted NOSES could reduce postoperative pain,lower the proportion of additional analgesia,relieve the body stress response,decrease the incidence of postoperative complications,and enhance recovery of gastrointestinal function.
作者
王帅
路继永
张成仁
杨熊飞
王涛
WANG Shuai;LU Jiyong;ZHANG Chengren;YANG Xiongfei;WANG Tao(The First School of Clinical Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China;School of Clinical Medicine,Ningxia Medical University,Yinchuan 750000,China;Department of Colorectal Surgery,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Clinical Research Center for Anorectal Diseases of Gansu Province,Lanzhou 730000,China)
基金
甘肃省肛肠疾病临床医学研究中心建设项目(20JR10RA434)。
