【作者】 李静；

【导师】 朱冰；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2018， 硕士

【摘要】 目的:系统性评价达芬奇机器人辅助胸外科手术(robotic-assisted thoracic surgery,RATS)与胸腔镜辅助下胸外科手术(video assisted thoracic surgery,VATS)治疗非小细胞癌(non-small cell lung cancer,NSCLC)的有效性和安全性。方法:电子计算机检索PubMed、EMBASE、Cochrane Library、知网、维普和万方等数据库,检索时间截至2017年12月,收集达芬奇机器人辅助胸外科手术(RATS)与胸腔镜辅助胸外科手术(VATS)治疗非小细胞肺癌(NSCLC)的对比研究。之后由2名研究员分别对所选取的文献提取数据和质量评价,最后采用Cochrane协作网提供的Revman 5.3软件进行统计学分析。结果:共有10篇回顾性临床对照研究被纳入,meta分析结果显示,对于NSCLC患者,RATS与VATS在术中失血量(MD=-49.91,95%CI:-112.11~12.29,P=0.12>0.05)、术后住院时间(MD=-0.03,95%CI:-0.66~0.59,P=0.92>0.05)、淋巴结清扫数(MD=3.32,95%CI:-0.67~7.32,P=0.10>0.05)、手术时间(MD=33.49,95%CI:3.16~63.81,P=0.03<0.05)、术后并发症(OR=0.99,95%CI:0.88~1.11,P=0.86>0.05)、术后院内死亡数(OR=0.99,95%CI:0.75~1.31,P=0.93>0.05)、中转开胸数(OR=0.55,95%CI:0.18~1.64,P=0.28>0.05)上无统计学方面的差异。结论:RATS与VATS胸外科手术治疗NSCLC患者都能取得较好的安全性和有效性。RATS辅助胸外科手术在术中失血量、术后住院时间、淋巴结清扫数、手术时间、术后并发症、术后院内死亡数、中转开胸数方面与VATS辅助胸外科手术效果相当,能为NSCLC患者提供满意预后。但RATS辅助胸外科手术相比于VATS辅助胸外科手术在主刀医生的舒适度、3D视野及、学习简易度方面更有优势。RATS胸外科手术或许能成为治疗NSCLC患者的又一选择。更多还原

【Abstract】 Objective: Systematic evaluation the effectiveness and safety of robotic-assisted thoracic surgery(RATS)and video assisted thoracic surgery(VATS)versus non-small cell lung cancer(NSCLC)Methods: Electronic computers search databases such as PubMed,EMBASE,Cochrane Library,CNKI,VIP and Wanfang to collect clinical studies about RATS vs VATS for patients with NSCLC from inception to December 2017.Two researchers then performed data extraction and quality assessment on the selected literature,and finally used the Revman 5.3 software provided by the Cochrane Collaboration for statistical analysis.Result: A total of 10 retrospective clinical controlled studies were included.Meta analysis results showed that for NSCLC patients,RATS and VATS had intraoperative blood loss(MD =-49.91,95% CI:-112.11~12.29,P = 0.12> 0.05),Postoperative hospital stay(MD=-0.03,95%CI:-0.66 to 0.59,P=0.92>0.05),lymph node dissection(MD=3.32,95%CI:-0.67 to 7.32,P=0.10>0.05),Operative time(MD = 33.49,95% CI: 3.16 ~ 63.81,P = 0.03 <0.05),postoperative complications(OR = 0.99,95% CI: 0.88 ~ 1.11,P = 0.86> 0.05),postoperative hospital death The number(OR=0.99,95%CI:0.75~1.31,P=0.93>0.05),and the number of open thoracotomy(OR=0.55,95%CI: 0.18~1.64,P=0.28>0.05)were not statistically significant difference.Conclusion: RATS and VATS thoracic surgery for NSCLC patients can achieve better safety and effectiveness.RATS assisted thoracic surgery was equivalent to VATS assisted thoracic surgery in terms of intraoperative blood loss,postoperative hospital stay,number of lymph node dissections,operative time,postoperative complications,postoperative in-hospital deaths,and number of conversions to thoracotomy.Patients with NSCLC provide a satisfactory prognosis.However,RATS assisted thoracic surgery is superior to VATS assisted thoracic surgery in the surgeon’s comfort,3D visual field,and ease of learning.RATS thoracic surgery may be another option for patients with NSCLC.更多还原