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目的:比较机器人辅助结直肠癌手术(RCS)与腹腔镜结直肠癌手术(LCS)的临床疗效。方法:系统检索文献数据库,按照纳入、排除标准筛选符合标准的文献,用Review Manager 5.2进行Meta分析。结果:共纳入9篇文献,包括2项随机对照研究,7项高质量病例对照研究,共879例患者,其中RCS组416例,LCS组463例。Meta分析结果显示,与LCS组比较,RCS组手术时间延长(WMD=65.06,95%CI=37.14~92.99),但在术中出血量(WMD=-11.55,95%CI=-32.31~9.21)、术后24 h疼痛评分(WMD=-0.08,95%CI=-0.55~0.39)、术后排气时间(WMD=-0.04,95%CI=-0.21~0.13)、术后进食时间(WMD=-0.08,95%CI=-0.41~0.25)、住院时间(WMD=-0.67,95%CI=-1.50~0.17)、术中转开腹率(OR=0.60,95%CI=0.21~1.75)及并发症发生率(OR=1.04,95%CI=0.67~1.60)方面均无统计学差异(均P>0.05)。结论:RCS提供与LCS相当的安全性和有效性,且具有更清晰、更立体的手术视野,操作灵活,能够明显减轻外科医师生理疲劳,值得临床应用。
Objective: To compare the clinical efficacy of robotic assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). Methods: The literature database was searched systematically, and according to inclusion and exclusion criteria, the standard literatures were screened, and Meta-analysis was conducted with Review Manager 5.2. RESULTS: Nine articles were included, including two randomized controlled studies and seven high-quality case-control studies in 879 patients, 416 in the RCS group and 463 in the LCS group. Meta analysis showed that the operation time of RCS group was longer than that of LCS group (WMD = 65.06,95% CI = 37.14 ~ 92.99), but the intraoperative blood loss (WMD = -11.55,95% CI = -32.31 ~ 9.21) (WMD = -0.08, 95% CI = -0.55-0.39), postoperative exhaust time (WMD = -0.04, 95% CI = -0.21-0.13), postoperative eating time = -0.08, 95% CI = -0.41 ~ 0.25), hospital stay (WMD = -0.67, 95% CI = -1.50 ~ 0.17) (OR = 1.04, 95% CI = 0.67-1.60). There was no significant difference between the two groups (all P> 0.05). CONCLUSIONS: RCS provides considerable safety and effectiveness compared with LCS, and has a clearer and more stereoscopic surgical field of view, flexible operation and obvious reduction of surgeon physiological fatigue, which is worthy of clinical application.