胸腔镜、机器人辅助胸腺切除术安全性及短期效果的meta分析
Meta-analysis of safety and short-term outcomes for different thymectomies

目的:系统评价机器人与胸腔镜两种术式在胸腺切除术中的安全性与短期效果。方法:检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、中国知网、万方、维普数据库,收集自建库至2017年10月各数据库有关两种术式切除胸腺的随机对照研究、队列研究或病例对照研究,经过筛选,最终9篇文献纳入研究,其中机器人辅助胸腺切除术366例,胸腔镜辅助胸腺切除术431例。利用Stata 14.0进行meta分析。结果:Meta分析结果显示,与胸腔镜辅助胸腺切除术组相比,机器人辅助胸腺切除术组术后带管时间短(SMD=-1.165,95%CI=-1.880～-0.451)、术中失血量少(SMD=-1.255,95%CI=-2.240～-0.271)、术后住院时间短(SMD=-1.008,95%CI=-1.562～-0.455),而手术时间、术后入住ICU时间、术后并发症及术中中转开胸数差异无统计学意义(P>0.05)。结论:与胸腔镜辅助胸腺切除术相比,机器人辅助胸腺切除术具有术中失血少,术后恢复快等优点。
Aim: To systematically evaluate the safety and efficiency of robot-assisted thymectomy and video-assisted thoracoscopic surgery thymectomy.Methods: PubMed, EMBASE, Cochrane Library,CBM, CNKI, Wan Fang and VIP Database were searched from the date of their establishment to October 2017 to collect the randomized controlled trials,cohort studies and case-control studies. Nine studies including 797 patients were finally selected, in which robot-assisted thymectomy had 366 cases and video-assisted thoracoscopic surgery thymectomy had 431 cases. Then meta-analysis was conducted using Stata 14.0 software.Results: Meta-analysis results showed that the robot-assisted thymectomy had less bleeding amount in operation(SMD was -1.255,95%CI from -2.240 to -0.271),less postoperative hospital stay(SMD was -1.008,95%CI from -1.562 to -0.455), and less drainage time(SMD was -1.165,95%CI from -1.880 to -0.451). While there was no significant difference in operation time, ICU days after operation, the postoperative complications,or the intraoperative transthoracic rate(P>0.05).Conclusion: Robot-assisted thymectomy is a recently emerging surgical method with less intraoperative blood loss, quick recovery after operation compared with video-assisted thoracoscopic surgery thymectomy