机器人与腹腔镜肝后段切除术：系统回顾与元分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-09-01 DOI:10.1016/j.hpb.2024.06.003

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引用次数: 0

摘要

背景对位于后上段（I、IVa、VII 和 VIII 段）的疑难病变进行微创肝切除术仍具有挑战性。与腹腔镜肝切除术（LLR）相比，机器人肝切除术（RLR）对后上段肝脏切除的价值仍存在争议。因此，我们进行了这项荟萃分析，以验证RLR在后上段的安全性和有效性。方法检索Medline、Embase、Web of Science和Cochrane Library电子数据库，以确定截至2023年10月发表的现有研究。结果本荟萃分析纳入了六项研究，共 2289 名患者（RLR：n = 749；LLR：n = 1540）。RLR 组术中失血较少（WMD = -119.54 ml，95% CI：-178.89 至 -60.19，P <；0.0001），输血较少（OR = 0.56，95% CI：0.39 至 0.80，P = 0.001），转换率较低（OR = 0.37，95% CI：0.23 至 0.61，P <；0.0001），手术时间更短（WMD = -27.16 min，95% CI：-35.95 to -18.36，P < 0.00001）。讨论与LLR相比，RLR治疗后上段病变安全有效，手术效果更优。

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Robotic versus laparoscopic liver resection for posterosuperior segments: a systematic review and meta-analysis

Background

Minimally invasive hepatectomy for difficult lesions located in posterosuperior segments (segments I, IVa, VII and VIII) remains challenging. The value of robotic liver resection (RLR) compared with laparoscopic liver resection (LLR) for posterosuperior segments is controversial. Therefore, we performed this meta-analysis to validate the safety and efficacy of RLR in posterosuperior segments.

Methods

The Medline, Embase, Web of Science, and Cochrane Library electronic databases were searched to identify available research published up to October 2023. Statistical analysis was performed with RevMan software version 5.3.

Results

Six studies with a total of 2289 patients (RLR: n = 749; LLR: n = 1540) were included in this meta-analysis. The RLR group had less intraoperative blood loss (WMD = −119.54 ml, 95% CI: −178.89 to −60.19, P < 0.0001), fewer blood transfusions (OR = 0.56, 95% CI: 0.39 to 0.80, P = 0.001), a lower conversion rate (OR = 0.37, 95% CI: 0.23 to 0.61, P < 0.0001), and a shorter operative time (WMD = −27.16 min, 95% CI: −35.95 to −18.36, P < 0.00001).

Discussion

Compared with LLR, RLR for lesions in the posterosuperior segments could be safe and effective, and it has superior surgical outcomes.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).