达芬奇机器人辅助与腹腔镜Nissen胃底折叠术治疗成人胃食管反流病的Meta分析

目的系统评价达芬奇机器人辅助Nissen胃底折叠术(robot-assisted Nissen fundoplication，RAF)与传统腹腔镜Nissen胃底折叠术(conventional laparoscopic Nissen fundoplication, CLF)比较治疗成人胃食管反流病(gastroesophageal reflux disease, GERD)的有效性和安全性。 方法计算机系统检索Pubmed、EMbase、Cochrane Library、Web of science、CNKI、WanFang Data和CBM数据库，同时追溯相关文献的参考文献，查找RAF与CLF比较治疗成人GERD的随机对照研究和队列研究，检索时间均限定为从建库至2018年6月30日。由2位研究员独立筛选文献、提取资料并进行纳入研究的质量评价，采用Stata/SE 12进行Meta分析，通过I²统计量反映纳入研究的异质性。 结果共纳入11篇文献，累计683例患者，其中RAF组267例、CLF组416例。Meta分析结果表明，与CLF组相比，RAF组手术时间更长(WMD＝28.83, 95%CI：12.89～44.76, P<0.05)、费用较高(P<0.05)；两组围手术期并发症发生率、术中中转率、术后气胸发生率、术后吞咽困难发生率、再手术率、住院时间比较，差异无统计学意义(P>0.05)。 结论研究结果表明，RAF在治疗成人GERD中有着良好的安全性和有效性。然而，鉴于RAF更长的手术时间和更高的手术费用，使其在临床上应用受到限制。

A Meta-analysis of da Vinci robotic-assisted versus laparoscopic Nissen fundoplication for adult gastroesophageal reflux disease

ObjectiveTo evaluate the efficacy and safety of da Vinci robotic-assisted Nissen fundoplication (RAF) versus conventional laparoscopic Nissen fundoplication (CLF) for adult gastroesophageal reflux disease through Meta-analysis. MethodsPubMed, EMbase, Cochrane Library, Web of science, CNKI, WanFang Data and CBM databases were systematically researched from their inception to Jun. 2018. We also hand searched the references lists of studies identified. We selected randomized controlled trials and cohort studies on the comparison of robotic versus conventional laparoscopic Nissen fundoplication (RAF vs CLF) for adult gastroesophageal reflux disease. After two researchers independently screen literature, extract available data and evaluate quality studies from the included studies, we performed meta-analysis by Stata/SE 12. Heterogeneity was assessed using the I² statistic. Results11 studies were included in the meta-analysis, in which 267 patients were in the RAF group and 416 patients were in the CLF group. The meta-analysis results indicated: compared to CLF, RAF was associated with longer estimated operative time(WMD=28.83, 95%CI: 12.89-44.76, P<0.05) and higher cost (P<0.05); However, there were no statistical difference between two groups in perioperative complications, intraoperative conversion rate, pneumothorax, postoperative dysphagia, reoperation and length of hospital stay (P>0.05). ConclusionsThis meta-analysis indicated that it was effective and safe for RAF in the treatment of adult gastroesophageal reflux disease. However, due to the longer operative time and higher operative cost of RAF, it was limited in clinical practice.