Chang Shang-Jen, Hsu Chun-Kai, Hsieh Cheng-Hsing, Yang Stephen Shei-Dei
Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.
School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
World J Urol. 2015 Nov;33(11):1855-65. doi: 10.1007/s00345-015-1526-3. Epub 2015 Mar 10.
This manuscript is mainly to systemically review the published reports that compared the efficacy and safety of robotic-assisted (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO).
We did a systemic search in the PubMed(®) for all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with UPJO. Two of the authors (Hsu and Chang) independently did the literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan(®), version 5.3). The end points of the analysis and review included age, operative time, hospital stay, costs, complications, and success rate.
In total, seven comparative trials and three studies using national database met the criteria that comprised 20,691 (RP:OP = 1956:18,735) patients in the meta-analysis. Most studies reported median value of patient age, operative time, and hospital stay. Only a small proportion of studies could be included for meta-analysis. The enrolled trials revealed that RP was more frequently performed in older children, required longer operative time, and shorter hospital stay. The postoperative success rate was comparable (RR = 0.99, 95 CI 0.94-1.04). Comparing with OP, there was a significant higher complication rate (RR = 1.29, 95 CI 1.10-1.51) and higher costs in the RP group.
Robotic-assisted pyeloplasty may be a promising alternative minimal invasive surgery for UPJO in children if the higher complication rates and higher costs in the RP can be overcome in the near future.
本论文主要系统回顾已发表的报告，这些报告比较了机器人辅助肾盂成形术（RP）与开放性肾盂成形术（OP）在输尿管肾盂连接部梗阻（UPJO）患儿中的疗效和安全性。
我们在PubMed（®）中进行了系统检索，以查找所有比较机器人辅助与开放性肾盂成形术治疗UPJO患儿手术结果的随机对照试验或比较研究。两位作者（Hsu和Chang）独立进行文献检索、质量评估和数据提取。使用Cochrane协作网综述管理器（RevMan（®），版本5.3）对获得的数据进行分析。分析和综述的终点包括年龄、手术时间、住院时间、费用、并发症和成功率。
总共有7项比较试验和3项使用国家数据库的研究符合标准，在荟萃分析中纳入了20,691名患者（RP：OP = 1956：18,735）。大多数研究报告了患者年龄、手术时间和住院时间的中位数。只有一小部分研究可纳入荟萃分析。纳入的试验显示，RP在年龄较大的儿童中更常进行，手术时间更长，住院时间更短。术后成功率相当（RR = 0.99，95% CI 0.94 - 1.04）。与OP相比，RP组并发症发生率显著更高（RR = 1.29，95% CI 1.10 - 1.51）且费用更高。
如果在不久的将来能够克服RP较高的并发症发生率和较高的费用问题，机器人辅助肾盂成形术可能成为治疗儿童UPJO的一种有前景的替代微创手术。
