Perioperative efficacy of robotic versus open approach for pancreaticoduodenectomy: a Meta-analysis
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摘要:
胰十二指肠切除术（PD）是胰腺外科极具挑战的一项手术。机器人手术系统在精细操作方面具有明显优势,在特定患者中,微创（腹腔镜及机器人手术系统）PD较常规开腹PD创伤更小,展现出良好的安全性及可行性。机器人手术系统与腹腔镜系统在手术视野、手术操作和吻合方式上存在差异。笔者查阅国内外相关文献,采用Meta分析评价机器人手术系统与开腹PD围手术期的疗效。
Abstract:Pancreatoduodenectomy (PD) is a very challenging operation in pancreatic surgery. Robotic surgery system has obvious advantages in precise operation. In specific patients, minimally invasive (laparoscopic and robotic surgery system) PD is less invasive than conventional open PD, showing good safety and feasibility. There are some differences between robotic surgery system and laparoscopic system in surgical field of vision, surgical operation and anastomosis mode. The authors review the relevant studies and conduct a Meta‑analysis to evaluate the perioperative efficacy of robotic versus open approach for PD.
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所有作者均声明不存在利益冲突张涛, 杨建武, 李连勇, 等. 机器人手术系统与开腹胰十二指肠切除术围手术期疗效的Meta分析[J]. 中华消化外科杂志, 2022, 21(11): 1482-1490. DOI: 10.3760/cma.j.cn115610-20220925-00546.
http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20220925-22546
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图 2 机器人组与开腹组患者手术时间的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 2. Results of Meta‑analysis on operation time between patients in the robotic group and the open group
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图 3 15篇纳入文献发表偏倚的Meta分析漏斗图
Figure 3. Funnel plot of Meta⁃analysis for publication bias of the 15 included literatures
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图 4 机器人组与开腹组患者术中出血量的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 4. Results of Meta‑analysis on the volume of intraoperative blood loss between patients in the robotic group and the open group
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图 5 9篇纳入文献发表偏倚的Meta分析漏斗图
Figure 5. Funnel plot of Meta⁃analysis for publication bias of the 9 included literatures
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图 6 机器人组与开腹组患者淋巴结清扫数目的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 6. Results of Meta‑analysis on the number of lymph nodes dissected between patients in the robotic group and the open group
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图 7 6篇纳入文献发表偏倚的Meta分析漏斗图
Figure 7. Funnel plot of Meta⁃analysis for publication bias of the 6 included literatures
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图 8 机器人组与开腹组患者R0切除率的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 8. Results of Meta‑analysis on the R0 resection rate between patients in the robotic group and the open group
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图 9 11篇纳入文献发表偏倚的Meta分析漏斗图
Figure 9. Funnel plot of Meta⁃analysis for publication bias of the 11 included literatures
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图 10 机器人组与开腹组患者总体并发症发生率的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 10. Results of Meta‑analysis on the incidence of total complications between patients in the robotic group and the open group
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图 11 12篇纳入文献发表偏倚的Meta分析漏斗图
Figure 11. Funnel plot of Meta⁃analysis for publication bias of the 12 included literatures
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图 12 机器人组与开腹组患者发生切口感染的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 12. Results of Meta‑analysis on the incidence of incision infection between patients in the robotic group and the open group
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图 13 12篇纳入文献发表偏倚的Meta分析漏斗图
Figure 13. Funnel plot of Meta⁃analysis for publication bias of the 12 included literatures
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图 14 机器人组与开腹组患者发生胃排空延迟的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 14. Results of Meta‑analysis on the incidence of delayed gastric emptying between patients in the robotic group and the open group
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图 15 10篇纳入文献发表偏倚的Meta分析漏斗图
Figure 15. Funnel plot of Meta⁃analysis for publication bias of the 10 included literatures
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图 16 机器人组与开腹组患者发生术后胆漏的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 16. Results of Meta‑analysis on the incidence of post⁃operative biliary leakage between patients in the robotic group and the open group
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图 17 8篇纳入文献发表偏倚的Meta分析漏斗图
Figure 17. Funnel plot of Meta⁃analysis for publication bias of the 8 included literatures
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图 18 机器人组与开腹组患者发生术后胰瘘的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 18. Results of Meta‑analysis on the incidence of post⁃operative pancreatic leakage between patients in the robotic group and the open group
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图 19 14篇纳入文献发表偏倚的Meta分析漏斗图
Figure 19. Funnel plot of Meta⁃analysis for publication bias of the 14 included literatures
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图 20 机器人组与开腹组患者二次手术的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 20. Results of Meta‑analysis on the reoperation between patients in the robotic group and the open group
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图 21 14篇纳入文献发表偏倚的Meta分析漏斗图
Figure 21. Funnel plot of Meta⁃analysis for publication bias of the 14 included literatures
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图 22 机器人组与开腹组患者术后病死率的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 22. Results of Meta‑analysis on the postoperative mortality between patients in the robotic group and the open group
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图 23 12篇纳入文献发表偏倚的Meta分析漏斗图
Figure 23. Funnel plot of Meta⁃analysis for publication bias of the 12 included literatures
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图 24 机器人组与开腹组患者住院时间的Meta分析结果
注：机器人组行机器人手术系统胰十二指肠切除术；开腹组行开腹胰十二指肠切除术
Figure 24. Results of Meta‑analysis on during of hospital stay between patients in the robotic group and the open group
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图 25 14篇纳入文献发表偏倚的Meta分析漏斗图
Figure 25. Funnel plot of Meta⁃analysis for publication bias of the 14 included literatures
表 1 纳入文献基本特征
Table 1 Characteristics of studies included in the Meta‑analysis
作者 发表年份 国家 研究类型 样本量（例） 机器人组（例） 开腹组（例） Zhou等[13] 2011 中国 非随机对照研究 16 8 8 Buchs等[14] 2011 美国 非随机对照研究 83 44 39 Chalikonda等[15] 2012 美国 非随机对照研究 60 30 30 Lai等[16] 2012 中国 非随机对照研究 87 20 67 Bao等[17] 2014 美国 非随机对照研究 56 28 28 Chen等[18] 2015 中国 非随机对照研究 180 60 120 Baker等[19] 2016 美国 非随机对照研究 71 22 49 Zureikat等[20] 2016 美国 非随机对照研究 1 028 211 817 Zimmerman等[21] 2018 美国 非随机对照研究 6 547 211 6 336 Napoli等[22] 2018 意大利 非随机对照研究 309 82 227 Kauffmann等[23] 2019 意大利 非随机对照研究 50 24 26 Shi等[24] 2020 中国 非随机对照研究 374 187 187 van Oosten等[25] 2021 荷兰 非随机对照研究 288 96 192 朱洪银等[26] 2020 中国 非随机对照研究 63 28 35 胡剑翀等[27] 2021 中国 非随机对照研究 96 26 70 
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表 2 非随机对照研究 Newcastle‑Ottawa Scale 量表（分)
Table 2 Newcastle‑Ottawa Scale for non‑randomized controlled trial (score)
纳入研究 研究人群选择 组间可比性 暴露因素测量 手术信息 总得分 确定恰当 代表性 对照选择 暴露因素确定 方法相同 遗失数据处理 Zhou等[13] 1 1 1 0 1 1 1 1 7 Buchs等[14] 1 1 1 1 1 1 1 1 8 Chalikonda等[15] 1 1 1 1 1 1 1 1 8 Lai等[16] 1 1 1 1 1 1 1 1 8 Bao等[17] 1 1 1 1 1 1 1 1 8 Chen等[18] 1 1 1 1 1 1 1 1 8 Baker等[19] 1 1 1 1 1 1 1 1 8 Zureikat等[20] 1 1 1 1 1 1 1 1 8 Zimmerman等[21] 1 1 1 0 1 1 1 1 7 Napoli等[22] 1 1 1 1 1 1 1 1 8 Kauffmann等[23] 1 1 1 0 1 1 1 1 7 Shi等[24] 1 1 1 1 1 1 1 1 8 van Oosten等[25] 1 1 1 1 1 1 1 1 8 朱洪银等[26] 1 1 1 0 1 1 1 1 7 胡剑翀等[27] 1 1 1 0 1 1 1 1 7
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