切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (03) : 296 -304. doi: 10.3877/cma.j.issn.1673-5250.2018.03.008

所属专题： 机器人手术； 文献；

论著

达芬奇机器人手术系统与腹腔镜手术在子宫内膜癌全面分期手术中安全性和有效性的Meta分析
王卫杰1, 高玲玲1, 徐建波1, 郭勤浩1, 高俊1, 张艳馨1, 罗嘉莉1, 顾扬1, 马志松1, 尹香花1,†()   
  1. 1. 225001　扬州，江苏省苏北人民医院妇产科
  • 收稿日期:2018-01-07 修回日期:2018-05-09 出版日期:2018-06-01
  • 通信作者: 尹香花

Safety and efficacy of Da Vinci surgical system versus laparoscopy for surgical staging of endometrial cancer: a Meta-analysis

Weijie Wang1, Lingling Gao1, Jianbo Xu1, Qinhao Guo1, Jun Gao1, Yanxin Zhang1, Jiali Luo1, Yang Gu1, Zhisong Ma1, Xianghua Yin1,†()   

  1. 1. Department of Obstetrics and Gynecology, Northern Jiangsu People′s Hospital, Yangzhou 225001, Jiangsu Province, China
  • Received:2018-01-07 Revised:2018-05-09 Published:2018-06-01
  • Corresponding author: Xianghua Yin
  • About author:
    Corresponding author: Yin Xianghua, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王卫杰, 高玲玲, 徐建波, 郭勤浩, 高俊, 张艳馨, 罗嘉莉, 顾扬, 马志松, 尹香花. 达芬奇机器人手术系统与腹腔镜手术在子宫内膜癌全面分期手术中安全性和有效性的Meta分析[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(03): 296-304.

Weijie Wang, Lingling Gao, Jianbo Xu, Qinhao Guo, Jun Gao, Yanxin Zhang, Jiali Luo, Yang Gu, Zhisong Ma, Xianghua Yin. Safety and efficacy of Da Vinci surgical system versus laparoscopy for surgical staging of endometrial cancer: a Meta-analysis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(03): 296-304.

目的

系统评价达芬奇机器人手术系统(DVSS)与腹腔镜手术在子宫内膜癌全面分期手术中的安全性与有效性。

方法

采用Cochrane系统评价法，应用计算机检索Cochrane library、PubMed、Embase、Web of Science(WOS)等英文数据库和中国知网(CNKI)、万方数据库、《中文科技期刊数据库》(CSTJ)等中文数据库；手工检索《国际肿瘤学杂志》《实用妇产科杂志》《中华妇产科杂志》《中国实用妇科与产科杂志》《现代妇产科进展》等中文期刊，检索年限为2007年1月1日至2017年8月31日，纳入DVSS与腹腔镜手术在子宫内膜癌全面分期手术的非随机对照试验(NRCT)。采用《纽卡斯尔-渥太华量表》(NOS)文献质量评价表，由2位经过该项目培训合格的研究者独立筛选文献、提取资料，并评价纳入研究的偏倚风险后，采用RevMan 5.3软件对DVSS和腹腔镜手术在子宫内膜癌全面分期手术中的安全性与有效性进行相关Meta分析。其中，安全性指标包括患者术中出血量、住院时间、中转开腹率、输血率、术中及术后并发症发生率，有效性指标包括手术时间、盆腔淋巴结切除数、腹主动脉旁淋巴结切除数。

结果

通过文献检查，并追踪检索已获取全文的相关参考文献，共计8篇符合本研究纳入标准，纳入患者为1 118例。在子宫内膜癌全面分期手术中，DVSS组患者为499例，腹腔镜手术组为619例。这8篇文献均为队列研究，其中前瞻性队列研究为3篇，回顾性队列研究为5篇。NOS量表评价文献质量均为高质量文献。本研究Meta分析结果显示，在子宫内膜癌全面分期手术中，①针对安全性方面的Meta分析结果显示，DVSS较腹腔镜手术具有患者术中出血量显著减少(SMD＝－88.95，95%CI：－102.42～－75.47，P<0.001)，住院时间显著缩短(SMD＝－0.40，95%CI：－0.75～－0.06，P＝0.02)，中转开腹率显著降低(RR＝0.37，95%CI：0.17～0.81，P＝0.01)，术中及术后并发症发生率显著降低(RR＝0.67，95%CI：0.51～0.87，P＝0.003)等优势，但2组患者的输血率比较，差异无统计学意义(RR＝0.76，95%CI：0.39～1.50，P＝0.43)。②针对有效性方面的Meta分析结果显示，2组患者的手术时间(SMD＝3.21, 95%CI：－21.51～27.93, P＝0.80)，盆腔淋巴结切除数(SMD＝－0.23, 95%CI：－3.06～2.60, P＝0.87)，及腹主动脉旁淋巴结切除数(SMD＝0.77, 95%CI：－1.69～3.23, P＝0.54)比较，差异均无统计学意义(P>0.05)。

结论

在子宫内膜癌全面分期手术中，与腹腔镜手术相比，DVSS具有术中导致的患者出血量少、中转开腹率低、术中及术后并发症发生率低、住院时间短等优势。但是，DVSS因其费用昂贵而使临床应用受到一定限制。

关键词: 子宫内膜肿瘤, 机器人手术, 腹腔镜, 队列研究, Meta分析, 妇女
Objective

To evaluate the safety and efficacy between Da Vinci surgical system (DVSS) and laparoscopy for surgical staging of endometrial cancer.

Methods

All the non-randomized controlled trials (NRCT) about robotic surgery and laparoscopy for surgical staging of endometrial cancer were electronically collected by searching English databases, including Cochrane library, PubMed, Embase, Web of Science (WOS), and Chinese databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (CSTJ). Meanwhile, Journal of International Oncology, Journal of Practical Obstetrics and Gynecology, Chinese Journal of Obstetrics and Gynecology, Chinese Journal of Practical Gynecology and Obstetrics, Progress in Obstetrics and Gynecology were manually searched to collect NRCT about the same topic. Retrieval time ranged from January 1, 2007 to August 31, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, Meta-analysis was performed by using RevMan 5.3 software.Heterogeneity inspection was done for each study, and different effect model, included the random effect model and fixed effect model was chose according to the results of the heterogeneity inspection. Meta-analysis was conducted to evaluate the efficacy and safety between robotic surgery and laparoscopy for surgical staging of endometrial cancer. The safety indexes included intraoperative blood loss, hospital stay, conversion to open surgery, blood transfusion rate, intraoperative and postoperative complications. The efficacy indexes included operation duration, the number of pelvic lymph node dissection and para-aortic lymph node dissection.

Results

A total of eight English NRCTs involving 1 118 patients were included.Among them, 499 patients received robotic surgery and 619 patients received laparoscopic surgery.All the 8 articles were cohort study, 3 were prospective cohort study, while 5 were retrospective cohort study. After the quality assessment, all studies were high quality. Meta-analysis showed the following results. ① In term of the safty, compared with laparoscopy surgery, robotic surgery had less intraoperative blood loss (SMD=-88.95, 95%CI: -102.42--75.47, P<0.001), shorter hospital stay (SMD=-0.40, 95%CI: -0.75--0.06, P=0.02), lower rate of conversion to open surgery (RR=0.37, 95%CI: 0.17-0.81, P=0.01), and lower rate of intraoperative or postoperative complications (RR=0.67, 95%CI: 0.51-0.87, P=0.003). But there was no statistically significant difference in term of blood transfusion rate (RR=0.76, 95%CI: 0.39-1.50, P=0.43). ②In terms of efficacy, there were no statistically significant differences in aspects of operative duration (SMD=3.21, 95%CI: -21.51-27.93, P=0.80), the number of pelvic lymph node dissection (SMD=-0.23, 95%CI: -3.06-2.60, P=0.87) and the number of para-aortic lymph node dissection (SMD=0.77, 95%CI: -1.69-3.23, P=0.54).

Conclusions

Compared the robotic surgery with laparoscopic surgery in surgical staging of endometrial cancer, robotic surgery has less intraoperative blood loss, lower rate of conversion to open surgery, lower rate of intraoperative or postoperative complications and shorter hospital stay. But the cost of robotic surgery is still expensive which restricts clinical application.

Key words: Endometrial neoplasms, Robotics, Laparoscopes, Cohort studies, Meta-analysis, Women
图1 文献检索流程及结果
表1 纳入研究的基本情况
纳入文献(第一作者，文献发表年) 国家及地区 研究类型 研究时间(年) 患者例数(例) 平均年龄(岁) 平均BMI(kg/m2)
DVSS组 腹腔镜组 DVSS组 腹腔镜组 DVSS组 腹腔镜组
Boggess，2008[6] 美国 PC，S 2005—2007 103 81 62 62 34.7 29.0
Lim，2010[7] 美国 PC，S 2008—2009 56 56 62 61 30.4 28.2
Jung，2010[8] 韩国 PC，M 2006—2009 28 25 53 50 23.4 25.2
Bell，2008[9] 美国 RC，S 2000—2007 40 30 63 68 33.0 31.9
Coronado，2012[10] 西班牙 RC，S 2003—2011 71 84 67 66 28.7 27.2
Cardenas-Goicoechea，2010[11] 美国 RC，S 2003—2009 102 173 62 60 32.3 32.7
Holtz，2010[12] 美国 RC，S 2005—2006 13 20 64 63 35.3 27.8
Chiou，2014[13] 中国台湾 RC，S 2005—2013 86 150 54 51 26.0 25.6
表2 纳入研究的方法学质量评价得分(分)
纳入文献(第一作者，文献发表年) 研究人群 干预措施 研究结果 总分
Boggess，2008[6] 3 2 2 7
Lim，2010[7] 2 2 2 6
Jung，2010[8] 4 2 2 8
Bell，2008[9] 3 2 2 7
Coronado，2012[10] 3 2 2 7
Cardenas-Goicoechea，2010[11] 4 2 2 8
Holtz，2010[12] 3 2 2 7
Chiou，2014[13] 2 2 2 6
图2 机器人手术组和腹腔镜手术组子宫内膜癌患者手术时间比较的随机效应模型的Meta分析结果
图3 机器人手术组和腹腔镜手术组子宫内膜癌患者术中出血量比较的固定效应模型的Meta分析结果
图4 机器人手术组和腹腔镜手术组子宫内膜癌患者住院时间比较的随机效应模型的Meta分析结果
图5 机器人手术组和腹腔镜手术组子宫内膜癌患者盆腔淋巴结比较的随机效应模型的Meta分析结果
图6 机器人手术组和腹腔镜手术组子宫内膜癌患者腹主动脉旁淋巴结比较的随机效应模型的Meta分析结果
图7 机器人手术组和腹腔镜手术组子宫内膜癌患者输血率比较的固定效应模型的Meta分析结果
图8 机器人手术组和腹腔镜手术组子宫内膜癌患者中转开腹比较的固定效应模型的Meta分析结果
图9 机器人手术组和腹腔镜手术组子宫内膜癌患者并发症发生率比较的固定效应模型的Meta分析结果
[1]
Jemal A, Bray F, Center MM, et al. Global cancer statistics [J]. CA Cancer J Clin, 2011, 61(2): 69-90.
[2]
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014 [J]. CA Cancer J Clin, 2014, 64(2): 104-117.
[3]
Wright JD, Ananth CV, Lewin SN, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease [J]. JAMA, 2013, 309(7): 689-698.
[4]
Silasi DA, Gallo T, Silasi M, et al. Robotic versus abdominal hysterectomy for very large uteri [J]. JSLS, 2013, 17(3): 400-406.
[5]
Martino MA, Berger EA, McFetridge JT, et al. A comparison of quality outcome measures in patients having a hysterectomy for benign disease: robotic vs. non-robotic approaches [J]. J Minim Invasive Gynecol, 2014, 21(3): 389-393.
[6]
Boggess JF, Gehrig PA, Cantrell L, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy [J]. Am J Obstet Gynecol, 2008, 199(4): 360. e1-e9.
[7]
Lim PC, Kang E, Park DH. Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer [J]. J Minim Invasive Gynecol, 17(6): 739-748.
[8]
Jung YW, Lee DW, Kim SW, et al. Robot-assisted staging using three robotic arms for endometrial cancer: comparison to laparoscopy and laparotomy at a single institution [J]. J Surg Oncol, 2010, 101(2): 116-121.
[9]
Bell MC, Torgerson J, Seshadri-Kreaden U, et al. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques [J]. Gynecol Oncol, 2008, 111(3): 407-411.
[10]
Coronado PJ, Herraiz MA, Magrina JF, et al. Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer [J]. Eur J Obstet Gynecol Reprod Biol, 2012, 165(2): 289-294.
[11]
Cardenas-Goicoechea J1, Adams S, Bhat SB, et al. Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center [J]. Gynecol Oncol, 2010, 117(2): 224-228.
[12]
Holtz DO, Miroshnichenko G, Finnegan MO, et al. Endometrial cancer surgery costs: robot vs laparoscopy [J]. J Minim Invasive Gynecol, 2010, 17(4): 500-503.
[13]
Chiou HY, Chiu LH, Chen CH, et al. Comparing robotic surgery with laparoscopy and laparotomy for endometrial cancer management: a cohort study [J]. Int J Surg, 2015, 13: 17-22.
[14]
Diaz-Arrastia C, Jurnalov C, Gomez G, et al. Laparoscopic hysterectomy using a computer-enhanced surgical robot [J]. Surg Endosc, 2002, 16(9): 1271-1273.
[15]
Kalogiannidis I, Lambrechts S, Amant F, et al. Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage Ⅰ endometrial cancer: safety, recurrence, and long-term outcome [J]. Am J Obstet Gynecol, 2007, 196(3): 248. e1-e8.
[16]
Holloway RW, Ahmad S, DeNardis SA, et al. Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance [J]. Gynecol Oncol, 2009, 115(3): 447-452.
[17]
Subramaniam A, Kim KH, Bryant SA, et al. A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma [J]. Gynecol Oncol, 2011, 122(3): 604-607.
[18]
Menderes G, Azodi M, Clark L, et al. Impact of body mass index on surgical outcomes and analysis of disease recurrence for patients with endometrial cancer undergoing robotic-assisted staging [J]. Int J Gynecol Cancer, 2014, 24(6): 1118-11125.
[19]
Eddib A, Danakas A, Hughes S, et al. Influence of morbid obesity on surgical outcomes in robotic-assisted gynecologic surgery [J]. J Gynecol Surg, 2014, 30(2): 81-86.
[20]
Jiménez Rodríguez RM, Díaz Pavón JM, de La Portilla de Juan F，et al. Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection [J]. Cir Esp, 2011, 89(7): 432-438.
[21]
Tozzi R, Malur S, Koehler C, et al. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study [J]. J Minim Invasive Gynecol, 2005, 12(2): 130-136.
[22]
Veljovich DS, Paley PJ, Drescher CW, et al. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging [J]. Am J Obstet Gynecol, 2008, 198(6): 679. e1-e9; discussion 679. e9-e10.
[23]
DeNardis SA, Holloway RW, Bigsby GE 4th, et al. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer [J]. Gynecol Oncol, 2008, 111(3): 412-417.
[24]
Magrina JF, Kho RM, Weaver AL, et al. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy [J]. Gynecol Oncol, 2008, 109(1): 86-91.
[25]
Kabat GC, Xue X, Kamensky V, et al. Risk of breast, endometrial, colorectal, and renal cancers in postmenopausal women in association with a body shape index and other anthropometric measures [J]. Cancer Causes Control, 2015, 26(2): 219-229.
[26]
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium [J]. Int J Gynaecol Obstet, 2009, 105(2): 103-104.
[27]
Case AS, Rocconi RP, Straughn JM, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer [J]. Obstet Gynecol, 2006, 108(6): 1375-1379.
[28]
Soucie JE, Chu PA, Ross S, et al. The risk of diagnostic hysteroscopy in women with endometrial cancer [J]. Am J Obstet Gynecol, 2012, 207(1): 71.
[1] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[2] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[3] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[4] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[5] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[6] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[7] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[8] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[9] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[10] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[11] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[12] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[13] 张继新, 胡军红, 谢爽, 武祖印, 张春旭. 经阴道单孔腹腔镜阑尾切除术可行性及近期疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 460-465.
[14] 卢艳军, 马健, 白鹏宇, 郭凌宏, 刘海义, 江波, 白文启, 张毅勋. 纳米碳在腹腔镜直肠癌根治术中253组淋巴结清扫的临床效果[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 473-477.
[15] 邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号