本文選題：機(jī)器人輔助　切入點(diǎn)：腹腔鏡　出處：《新疆醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在泌尿外科已廣泛應(yīng)用,雖然它的優(yōu)勢(shì)明顯,但就目前而言,機(jī)器人輔助腎部分切除術(shù)和腹腔鏡腎部分切除術(shù)的臨床效果和安全性仍存在一定爭(zhēng)論。目的評(píng)價(jià)機(jī)器人輔助的腎部分切除術(shù)和腹腔鏡腎部分切除術(shù)的臨床效果。方法以"Robotics AND Nephrectomy"、"Robotics AND Nephrectomy AND Laparoscopy"、" Robotics AND Laparoscopy AND Nephrectomy AND Partial"、"LPN AND RPN"“機(jī)器人輔助腎部分切AND腹腔鏡腎部分切除術(shù)”為關(guān)鍵詞,在Pubmed、CNKI、維普數(shù)據(jù)庫(kù)中檢索截止至2013年05月31日前發(fā)表的隨機(jī)對(duì)照試驗(yàn),根據(jù)納入和排除標(biāo)準(zhǔn)篩選納入的文獻(xiàn),并提取所需數(shù)據(jù),應(yīng)用Review Manager5.2.5(Java6)軟件進(jìn)行數(shù)據(jù)處理,對(duì)機(jī)器人輔助腎部分切除術(shù)和傳統(tǒng)腹腔鏡腎部分切除術(shù)兩組在估計(jì)出血量、手術(shù)時(shí)間、熱缺血時(shí)間、切緣陽(yáng)性、并發(fā)癥及住院時(shí)間六個(gè)方面進(jìn)行Meta分析。結(jié)果最終共篩選出7篇文獻(xiàn),均為外文文獻(xiàn),Meta分析中具體統(tǒng)計(jì)量值如下：估計(jì)失血量[I2=77%,MD=-10.01,95%CI(-62.74,42.72), Z=0.37, P=0.71];手術(shù)時(shí)間[I2=92%, MD=-4.54,95%CI(-29.04,19.96), Z=0.36, P=0.72];熱缺血時(shí)間[MD=-1.47,95%CI[-2.82,-0.11] Z=2.12, P=0.03];并發(fā)癥[OR=1.35,95%CI(0.67,2.74), Z=0.84, P=0.40];切緣陽(yáng)性[OR=1.91,95%CI (0.50,7.29), Z=0.95, P=0.34];住院時(shí)間[MD=-0.08,95%CI(-0.37,0.22), Z=0.50, P=0.62]。其中熱缺血時(shí)間的兩組間差異有統(tǒng)計(jì)學(xué)意義,說明RPN組在熱缺血時(shí)間上優(yōu)于LPN組,即同LPN相比,RPN對(duì)腎臟損傷更小、可更好地保護(hù)腎功能。而估計(jì)出血量等其他各比較均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論RPN與LPN兩種術(shù)式的手術(shù)效果基本一致,而前者的腎熱缺血時(shí)間較短,這對(duì)保護(hù)腎功能有積極的作用,同時(shí)也對(duì)臨床如何選擇手術(shù)方式提供了依據(jù)。
[Abstract]:Background Leonardo da Vinci robotic surgery system has been widely used in urology. Although its advantages are obvious, The clinical efficacy and safety of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy are still controversial. Objective to evaluate the clinical effects of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy. Methods "Robotics AND Nephrectomy", "Robotics AND Nephrectomy AND Laparoscopy", "Robotics AND Laparoscopy AND Nephrectomy AND Partial", "LPN AND RPN" "robot-assisted partial nephrectomy" were used as the key words. A randomized controlled trial published up to May 31st 2013 was searched in the Pubmedan CNKI database. According to the inclusion and exclusion criteria, the selected literatures were selected, and the required data were extracted, and the data were processed with Review Manager 5.2.5 Java 6 software. In the two groups, robot-assisted partial nephrectomy and traditional laparoscopic partial nephrectomy were used to estimate blood loss, operative time, warm ischemic time, positive margin. Meta analysis was carried out in six aspects of complications and hospital stay. The specific statistical values in the meta-analysis of the foreign literature are as follows: estimated blood loss [I2O77MD-10.0195 CIQ [-62.742], Z0.37, P0.71]; operative time [I2O922, MD-4.595CI-29.095CI-29.095 CI-29.0495 CI-29.0495 CI-29.0495, Z0.36, P0.72]; hot ischemic time [MD-1.4795CI [-2.82mc-0.11] Z 2.12, P0.03]; complications [OR1.3595CIA 72.74, ZJU 40.74, P0.40]; The difference between the two groups is statistically significant. The results showed that the RPN group was superior to the LPN group in the time of hot ischemia, that is, compared with the LPN group, the renal injury was less in the RPN group. Conclusion the effect of RPN and LPN is basically the same, and the time of renal ischemia is shorter in the former, which has a positive effect on the protection of renal function. At the same time, it also provides the basis for how to choose the operation mode.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.11

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