本文選題：機器人輔助　切入點：腹腔鏡　出處：《新疆醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：背景達芬奇機器人手術系統(tǒng)在泌尿外科已廣泛應用,雖然它的優(yōu)勢明顯,但就目前而言,機器人輔助腎部分切除術和腹腔鏡腎部分切除術的臨床效果和安全性仍存在一定爭論。目的評價機器人輔助的腎部分切除術和腹腔鏡腎部分切除術的臨床效果。方法以"Robotics AND Nephrectomy"、"Robotics AND Nephrectomy AND Laparoscopy"、" Robotics AND Laparoscopy AND Nephrectomy AND Partial"、"LPN AND RPN"“機器人輔助腎部分切AND腹腔鏡腎部分切除術”為關鍵詞,在Pubmed、CNKI、維普數(shù)據(jù)庫中檢索截止至2013年05月31日前發(fā)表的隨機對照試驗,根據(jù)納入和排除標準篩選納入的文獻,并提取所需數(shù)據(jù),應用Review Manager5.2.5(Java6)軟件進行數(shù)據(jù)處理,對機器人輔助腎部分切除術和傳統(tǒng)腹腔鏡腎部分切除術兩組在估計出血量、手術時間、熱缺血時間、切緣陽性、并發(fā)癥及住院時間六個方面進行Meta分析。結果最終共篩選出7篇文獻,均為外文文獻,Meta分析中具體統(tǒng)計量值如下：估計失血量[I2=77%,MD=-10.01,95%CI(-62.74,42.72), Z=0.37, P=0.71];手術時間[I2=92%, MD=-4.54,95%CI(-29.04,19.96), Z=0.36, P=0.72];熱缺血時間[MD=-1.47,95%CI[-2.82,-0.11] Z=2.12, P=0.03];并發(fā)癥[OR=1.35,95%CI(0.67,2.74), Z=0.84, P=0.40];切緣陽性[OR=1.91,95%CI (0.50,7.29), Z=0.95, P=0.34];住院時間[MD=-0.08,95%CI(-0.37,0.22), Z=0.50, P=0.62]。其中熱缺血時間的兩組間差異有統(tǒng)計學意義,說明RPN組在熱缺血時間上優(yōu)于LPN組,即同LPN相比,RPN對腎臟損傷更小、可更好地保護腎功能。而估計出血量等其他各比較均無統(tǒng)計學意義。結論RPN與LPN兩種術式的手術效果基本一致,而前者的腎熱缺血時間較短,這對保護腎功能有積極的作用,同時也對臨床如何選擇手術方式提供了依據(jù)。
[Abstract]:Background Leonardo da Vinci robotic surgery system has been widely used in urology. Although its advantages are obvious, The clinical efficacy and safety of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy are still controversial. Objective to evaluate the clinical effects of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy. Methods "Robotics AND Nephrectomy", "Robotics AND Nephrectomy AND Laparoscopy", "Robotics AND Laparoscopy AND Nephrectomy AND Partial", "LPN AND RPN" "robot-assisted partial nephrectomy" were used as the key words. A randomized controlled trial published up to May 31st 2013 was searched in the Pubmedan CNKI database. According to the inclusion and exclusion criteria, the selected literatures were selected, and the required data were extracted, and the data were processed with Review Manager 5.2.5 Java 6 software. In the two groups, robot-assisted partial nephrectomy and traditional laparoscopic partial nephrectomy were used to estimate blood loss, operative time, warm ischemic time, positive margin. Meta analysis was carried out in six aspects of complications and hospital stay. The specific statistical values in the meta-analysis of the foreign literature are as follows: estimated blood loss [I2O77MD-10.0195 CIQ [-62.742], Z0.37, P0.71]; operative time [I2O922, MD-4.595CI-29.095CI-29.095 CI-29.0495 CI-29.0495 CI-29.0495, Z0.36, P0.72]; hot ischemic time [MD-1.4795CI [-2.82mc-0.11] Z 2.12, P0.03]; complications [OR1.3595CIA 72.74, ZJU 40.74, P0.40]; The difference between the two groups is statistically significant. The results showed that the RPN group was superior to the LPN group in the time of hot ischemia, that is, compared with the LPN group, the renal injury was less in the RPN group. Conclusion the effect of RPN and LPN is basically the same, and the time of renal ischemia is shorter in the former, which has a positive effect on the protection of renal function. At the same time, it also provides the basis for how to choose the operation mode.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11

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