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目的系统评价达芬奇机器人辅助胸外科手术(robotic-assisted thoracic surgery,RATS)与胸腔镜辅助胸外科手术(video assisted thoracic surgery,VATS)对非小细胞癌(non-small cell lung cancer,NSCLC)的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年9期)、Web of Science、CNKI、VIP、Wan Fang Data和CBM数据库,搜集关于RATS与VATS对比进行NSCLC手术的临床研究,检索时限均为建库至2016年10月。由两名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入14个队列研究,包括19 921例NSCLC患者,其中RATS组4 322例,VATS组15 599例。Meta分析结果显示,RATS组的手术时间[MD=22.90,95%CI(9.97,35.84),P<0.000 5]明显长于VATS组。两组在术中中转开胸率[OR=0.72,95%CI(0.44,1.18),P=0.20]、术中并发症发生率[OR=1.06,95%CI(0.96,1.17),P=0.18]、术中失血量[MD=2.75,95%CI(–8.39,13.89),P=0.63]、术后住院时间[MD=–0.00,95%CI(–0.02,0.02),P=0.99]和术后院内死亡率[OR=0.60,95%CI(0.35,1.05),P=0.07]方面差异无统计学意义。结论现有证据表明RATS与VATS治疗NSCLC效果相当,但RATS手术时间较长。但受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究进行验证。
Objective To systematically evaluate the effects of da Vinci robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) on non-small cell lung cancer (NSCLC) Effectiveness and safety Methods We searched PubMed, EMbase, The Cochrane Library (2016), Web of Science, CNKI, VIP, Wan Fang Data and CBM database to collect clinical data of RATS and VATS for NSCLC. The retrieval time was Building the library until October 2016. After two researchers independently screened the literature, extracted data, and assessed the risk of bias in inclusion in the study, Meta-analysis was performed using Rev Man 5.3 software. Results A total of 14 cohort studies were included, including 19 921 NSCLC patients, including 4 322 in the RATS group and 15 599 in the VATS group. Meta-analysis showed that the operation time of the RATS group [MD = 22.90,95% CI (9.97, 35.84), P <0.0005] was significantly longer than that of the VATS group. The rate of intraoperative complications [OR = 1.06, 95% CI (0.96, 1.17), P = 0.18], intraoperative blood loss [MD = 2.75,95% CI (-8.39,13.89), P = 0.63], postoperative hospital stay [MD = -0.00,95% CI -0.02,0.02], P = ] And in-hospital mortality [OR = 0.60, 95% CI (0.35, 1.05), P = 0.07]. Conclusion The available evidence shows that RATS is equivalent to VATS in the treatment of NSCLC, but RATS surgery takes a long time. However, due to the limitation of the quantity and quality of the research, the above conclusion still needs to be verified by more high-quality research.