小儿肾盂输尿管连接部梗阻的机器人辅助与传统腹腔镜肾盂成形术：疗效、安全性及年龄分层结局的Meta分析

Robotic-assisted versus conventional laparoscopic pyeloplasty in pediatric ureteropelvic junction obstruction: a meta-analysis of efficacy, safety, and age-stratified outcomes.

作者信息

Kuiqing Li, Shangyan Hei, Cheng Liu, Zhuohang Li, Juanyi Shi, Cong Lai, Kewei Xu

机构信息

Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, China.

The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, China.

出版信息

J Robot Surg. 2025 Aug 2;19(1):443. doi: 10.1007/s11701-025-02621-w.

DOI:10.1007/s11701-025-02621-w

PMID:40753141

Abstract

To compare the efficacy and safety of robotic-assisted pyeloplasty (RALP) versus conventional laparoscopic pyeloplasty (CLP) in pediatric ureteropelvic junction obstruction (UPJO). A systematic review and meta-analysis was conducted, including randomized controlled trials and cohort studies from PubMed, EMBASE, and Cochrane Library (2000-2025). Outcomes assessed included success rates, operative time, length of hospital stay, intraoperative/postoperative complications and conversion rates. Subgroup analyses stratified patients by age (< 2 vs. ≥ 2 years) and anastomosis time to minimize heterogeneity from variable surgical phase definitions. Risk ratios (RR), mean differences (MD), and odds ratios (OR) were calculated using random-effects models. This meta-analysis of 26 studies (4066 pediatric patients) demonstrated consistent advantages for RALP over CLP. RALP was associated with a 54% lower odds of surgical failure (OR = 0.46, 95% CI 0.22-0.98, P = 0.04) and significantly shorter operative time (mean difference [MD] = - 17.3 min, 95% CI - 31.2 to - 3.4, P = 0.01), driven by a 28 min reduction in anastomotic time (MD = - 27.9, 95% CI - 52.9 to - 2.9, P = 0.03). RALP also reduced postoperative complications by 81% (OR = 1.81, 95% CI 1.21-2.69, P = 0.004), with a shorter hospital stay (MD = - 3.04 days, P < 0.00001). Subgroup analyses revealed stronger benefits in children ≥ 2 years (operative time MD = 17.27 min, P = 0.02), while infants < 2 years showed high heterogeneity (I = 91%). Conversion rates were comparable (1.1% vs. 1.0%, P = 0.74). RALP is associated with higher success rates, fewer complications, and shorter hospital stays compared to CLP in pediatric UPJO repair, particularly in older children. Standardized reporting of surgical phases and cost-effectiveness studies are needed to optimize robotic applications across pediatric populations.

摘要

比较机器人辅助肾盂成形术（RALP）与传统腹腔镜肾盂成形术（CLP）治疗小儿肾盂输尿管连接部梗阻（UPJO）的疗效和安全性。进行了一项系统评价和荟萃分析，纳入了来自PubMed、EMBASE和Cochrane图书馆（2000 - 2025年）的随机对照试验和队列研究。评估的结果包括成功率、手术时间、住院时间、术中/术后并发症及中转率。亚组分析根据年龄（<2岁与≥2岁）和吻合时间对患者进行分层，以尽量减少因手术阶段定义不同而产生的异质性。使用随机效应模型计算风险比（RR）、平均差（MD）和比值比（OR）。这项对26项研究（4066例小儿患者）的荟萃分析表明，RALP相对于CLP具有持续优势。RALP与手术失败几率降低54%相关（OR = 0.46，95%CI 0.22 - 0.98，P = 0.04），手术时间显著缩短（平均差[MD] = - 17.3分钟，95%CI - 31.2至 - 3.4，P = 0.01），这是由于吻合时间减少了28分钟（MD = - 27.9，95%CI - 52.9至 - 2.9，P = 0.03）。RALP还使术后并发症减少81%（OR = 1.81，95%CI 1.21 - 2.69，P = 0.004），住院时间缩短（MD = - 3.04天，P < 0.00001）。亚组分析显示，≥2岁儿童获益更大（手术时间MD = 17.27分钟，P = 0.02），而<2岁婴儿异质性较高（I = 91%）。中转率相当（1.1%对1.0%，P = 0.74）。与CLP相比，RALP在小儿UPJO修复中成功率更高、并发症更少、住院时间更短，尤其是在大龄儿童中。需要对手术阶段进行标准化报告并开展成本效益研究，以优化机器人在小儿群体中的应用。