中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (44): 8240-8245.doi: 10.3969/j.issn.2095-4344.2012.44.014

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

机器人辅助外科达芬奇手术系统Nissen在胃底折叠治疗中的Meta分析

范永刚，姚国良，刘可峰   

  1. 河南科技大学第一附属医院普外一科，河南省洛阳市 471003
  • 收稿日期:2012-01-15 修回日期:2012-02-26 出版日期:2012-10-28 发布日期:2012-10-28
  • 作者简介:范永刚☆，男，1968年生，河南省洛阳市人，汉族，2003年南京医科大学附属江苏省人民医院毕业，博士，副主任医师，主要从事胃肠道疾病的微创治疗研究。 ygl1982@msn.com

Meta analysis of robotic Nissen fundoplication for the treatment of gastroesophageal reflux disease

Fan Yong-gang, Yao Guo-liang, Liu Ke-feng   

  1. First Department of General Surgery, the First Affiliated Hospital of Henan Science and Technology University, Luoyang 471003, Henan Province, China
  • Received:2012-01-15 Revised:2012-02-26 Online:2012-10-28 Published:2012-10-28
  • About author:Fan Yong-gang☆, Doctor, Associate chief physician, First Department of General Surgery, the First Affiliated Hospital of Henan Science and Technology University, Luoyang 471003, Henan Province, China ygl1982@msn.com

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摘要：

背景：与传统腹腔镜技术相比，机器人辅助外科特别是达芬奇手术系统可以提供良好的三维成像技术、更好的人体生物工程学设计及更加精细的操作。
目的：通过Meta分析评价机器人辅助外科达芬奇手术系统Nissen胃底折叠在治疗胃食管反流性疾病中的安全性及可行性。
方法：运用计算机检索Embase、OVID及PubMed等数据库有关达芬奇系统辅助Nissen胃底折叠治疗胃食管反流性疾病的论文。根据数据类型不同，统计方法分别采用倒方差法和M-H法，并根据异质性分析结果分别采用随机效应模型和固定效应模型。
结果与结论：共纳入5篇文献，累计160例患者。Meta分析结果显示，除术中及术后并发症外，传统腹腔镜组与机器人Nissen胃底折叠组总手术时间、有效手术时间、术后吞咽困难发生率、中转开腹或中转为传统腹腔镜手术率、再手术率、住院时间及住院费用差异均无显著性意义(P > 0.05)。说明机器人Nissen胃底折叠在治疗胃食管反流行疾病时并不优于传统腹腔镜手术，因此应谨慎选择适应证。

关键词: 机器人手术, 达芬奇手术系统, Nissen胃底折叠, 胃食管反流性疾病(GERD), Meta分析

Abstract:

BACKGROUND: Compared with conventional laparoscopic techniques, robot-assisted surgery, especially the Da Vinci Surgical System, can provide a good three-dimensional imaging, better human bioengineering design and more sophisticated operations.
OBJECTIVE: To evaluate the efficacy and feasibility of robotic Nissen fundoplication for the treatment of gastroesophageal reflux disease through Meta-analysis.
METHODS: A comprehensive search of PubMed database, Embase database and OVID database was performed by computer to determine all published research papers on the comparison of robotic versus conventional laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease. The inverse-variance method and Mantel-Haenszel method were used for the analysis depending on the data type with fixed effect model or random effect model according to the heterogeneity.
RESULTS AND CONCLUSION: Five studies met the criteria finally, which included 160 patients. Meta analysis showed that except the intraoperative and postoperative complications, statistical differences were not observed in the other outcomes between conventional laparoscopic group and robotic Nissen fundoplication group, including total operating interval, effective operating interval, postoperative dysphagia, conversions, re-operation rate, hospital stay and in-hospital costs (P > 0.05). It indicates that the robotic Nissen fundoplication is not superior to the traditional laparoscopic surgery in the treatment of gastroesophageal reflux disease. Therefore, we should select the indications carefully.

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