本文選題：胃癌根治術(shù)　切入點(diǎn)：達(dá)芬奇機(jī)器人　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對(duì)已發(fā)表的臨床研究進(jìn)行Meta分析,系統(tǒng)性評(píng)價(jià)達(dá)芬奇手術(shù)機(jī)器人與腹腔鏡和開腹手術(shù)在治療胃癌方面的近期臨床療效和安全性。方法:檢索the Cochrane Library、PubMed、EMBASE、Web of Science、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBMdisc)、中國(guó)知網(wǎng)(CNKI)、中文科技期刊全文數(shù)據(jù)庫(kù)(VIP)以及萬(wàn)方數(shù)據(jù)庫(kù),檢索時(shí)間為2000年07月至2016年04月,語(yǔ)種限定為英文。納入符合要求的臨床隨機(jī)對(duì)照試驗(yàn)(Randomized Controlled Trials,RCTs)、回顧性觀察研究(Retrospective observational research,Retro)及回顧性非隨機(jī)對(duì)照研究(Retrospective Non-randomized Trial,RNT),由2名研究員分別獨(dú)立提取數(shù)據(jù)并進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià),用Revman5.3和Sata12.0軟件進(jìn)行Meta分析。研究指標(biāo)為出血量(Evaluated Blood Loss,EBL)、術(shù)后通氣時(shí)間(Day of First Flatus)、術(shù)后首次進(jìn)食時(shí)間(Days of eating liquid diets),收獲淋巴結(jié)數(shù)量(Number of harvested lymph nodes)、術(shù)后住院天數(shù)(Length of postoperative hospital stay)及吻合口瘺、腸梗阻、肺部感染、傷口感染、死亡等并發(fā)癥。結(jié)果:最終納入14篇文獻(xiàn),其中回顧性研究13篇,隨機(jī)對(duì)照研究1篇,共10255例胃癌患者,其中開腹組5285例,腔鏡組3283例,機(jī)器人組687例。達(dá)芬奇機(jī)器人組同腹腔鏡組對(duì)比,達(dá)芬奇機(jī)器人組在胃癌根治術(shù)中的出血量少于腹腔鏡組[95%可信區(qū)間(CI):-21.97—-16.28],清掃淋巴結(jié)總數(shù)大于腹腔鏡組[95%CI:1.03-2.31],術(shù)后通氣時(shí)間短于腹腔鏡組[95%CI:-0.37—-0.17],術(shù)后住院天數(shù)短于腹腔鏡組[95%CI:-0.8—-0.41]。術(shù)后吻合口瘺、腸梗阻、肺部感染、傷口感染、死亡等并發(fā)癥的發(fā)生率在兩組之間均無(wú)統(tǒng)計(jì)學(xué)差異。機(jī)器人組同開腹組對(duì)比,出血量顯著少于后者[95%可信區(qū)間(CI):-89.72—-68.52],術(shù)后通氣時(shí)間短于開腹組[95%可信區(qū)間(CI):-0.47—-0.22],術(shù)后首次進(jìn)食時(shí)間短于開腹組[95%可信區(qū)間(CI):-1.35—-1.01],術(shù)后住院天數(shù)短于開腹組[95%可信區(qū)間(CI):-1.60—-0.74]。在術(shù)后并發(fā)癥中,達(dá)芬奇機(jī)器人組較腹腔鏡組及開腹組發(fā)生例數(shù)無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論:達(dá)芬奇機(jī)器人胃癌手術(shù)相較傳統(tǒng)腹腔鏡胃癌手術(shù)與開腹胃癌而言,創(chuàng)傷更小,術(shù)后恢復(fù)更快,清掃淋巴結(jié)數(shù)量更多,可在今后的臨床工作中推廣使用。
[Abstract]:Objective: to carry out Meta analysis of published clinical studies. Methods: the clinical efficacy and safety of Leonardo da Vinci surgical robot, laparoscopy and laparotomy in the treatment of gastric cancer were systematically evaluated. Methods: the Cochrane Library PubMedus the of Science, Chinese Biomedical Literature Database, CNKI, Chinese. Full text Database of Sci-tech Journals (VIPs) and Wanfang Database, The retrieval time is from July 2000 to April 2016, The language was limited to English. The randomized Controlled trials were included in the randomized Controlled trials, retrospective observational research and retrospective non-randomized control studies. The two researchers independently extracted the data and evaluated the quality of the literature. Meta analysis was carried out with Revman5.3 and Sata12.0 software. The indexes were: blood loss, postoperative ventilation time, days of eating liquid dietsm, number of lymph nodes of harvested lymph nodeses, length of length of postoperative hospital stoma and anastomotic fistula. Results: 14 literatures were included, including 13 retrospective studies and 1 randomized controlled study. There were 10255 patients with gastric cancer, including 5285 patients in the open group and 3283 in the endoscopic group. Robot group 687 cases. Leonardo da Vinci robot group compared with laparoscopic group, The amount of bleeding in the da Vinci robot group was less than that in the laparoscopic group [95% CI: -21.97-16.28], the total number of lymph nodes dissected was larger than that in the laparoscopic group [95CI: 1.03-2.31], the postoperative ventilation time was shorter than that in the laparoscopic group [95CI: -0.37-0.17], the postoperative hospital stay was shorter than that in the laparoscope group [95CIwar-0.8-0.41]. The incidence of intestinal obstruction, lung infection, wound infection and death was not significantly different between the two groups. The amount of bleeding was significantly less than that of the latter group [95% CI: 89.72-68.52], the postoperative ventilation time was shorter than that in the open group [95% confidence interval CI: -0.47 -0.22], the first time of eating after operation was shorter than that in the open group [95% confidence interval], and the postoperative hospital stay was shorter than that in the open group [95% confidence interval CI: -1.60-0.74]. There was no significant difference in the number of cases in the da Vinci robot group compared with the laparoscopic group and the open group. Conclusion: compared with the traditional laparoscopic and open gastric cancer surgery, the da Vinci robot gastric cancer group has less trauma and faster recovery after operation. More lymph node dissection can be used in clinical work in the future.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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