机器人对比腹腔镜食管裂孔疝修补术的围手术期安全性特征：系统评价与荟萃分析

文献信息

中文摘要

背景： 机器人食管裂孔疝修补术（RHHR）的应用日益增多，但与腹腔镜食管裂孔疝修补术（LHHR）相比，其技术优势是否能改善围手术期安全性仍不确定。我们比较了RHHR与LHHR的短期安全性特征，特别关注器官特异性术后并发症。
方法： 检索MEDLINE（通过PubMed）、Web of Science、Embase和Cochrane Library自建库至2025年7月15日的文献，纳入成人RHHR与LHHR的比较研究。研究筛选和数据提取由两名评价者独立完成。主要结局为总体术后并发症；次要结局包括心血管、呼吸和泌尿系统并发症、吞咽困难、手术时间、术中并发症、30天再入院、死亡率和住院时间。采用纽卡斯尔-渥太华量表评估队列研究的偏倚风险，并使用GRADE评估证据确定性。酌情合并比值比（OR）和均数差（MD）及其95%置信区间（CI）。
结果： 共纳入11项比较研究（10项回顾性、1项前瞻性），涉及696,886例患者。RHHR与LHHR的总体术后并发症无显著差异（OR 1.14，95% CI 0.98-1.33）。RHHR与较少的术中并发症（OR 0.42，95% CI 0.24-0.73）和略短的住院时间（MD -0.40天，95% CI -0.78至-0.02）相关。相反，RHHR与更高的心血管事件（OR 1.24，95% CI 1.17-1.31）、呼吸系统并发症（OR 1.65，95% CI 1.59-1.71）、30天再入院（OR 1.23，95% CI 1.19-1.27）和死亡率（OR 1.26，95% CI 1.11-1.43）几率相关。泌尿系统并发症、术后吞咽困难或总体手术时间未见显著差异。证据确定性为低至极低。
结论： 截至2025年7月15日检索到的比较证据提示，RHHR与LHHR术后总体并发症发生率大致相似。RHHR可能与较少的术中并发症和较短的住院时间相关，但观察到的与心肺事件、再入院和死亡率更高几率的相关性应谨慎解读，因为证据主要为观察性研究，易受残余混杂、病例组合差异和数据库相关偏倚的影响。
系统评价注册： https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251102047，PROSPERO注册号CRD420251102047。

英文摘要

BACKGROUND: Robotic hiatal hernia repair (RHHR) is increasingly used, but whether its technical advantages improve perioperative safety compared with laparoscopic hiatal hernia repair (LHHR) remains uncertain. We compared the short-term safety profiles of RHHR and LHHR, with particular attention to organ-specific postoperative complications.
METHODS: MEDLINE (via PubMed), Web of Science, Embase, and the Cochrane Library were searched from inception through 15 July 2025 for comparative studies of RHHR and LHHR in adults. Study selection and data extraction were performed independently by two reviewers. The primary outcome was overall postoperative complications; secondary outcomes included cardiovascular, respiratory, and urological complications, dysphagia, operative time, intraoperative complications, 30-day readmission, mortality, and length of stay. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies, and certainty of evidence was evaluated using GRADE. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled as appropriate.
RESULTS: Eleven comparative studies (10 retrospective and one prospective) involving 696,886 patients were included. Overall postoperative complications did not differ significantly between RHHR and LHHR (OR 1.14, 95% CI 0.98-1.33). RHHR was associated with fewer intraoperative complications (OR 0.42, 95% CI 0.24-0.73) and a modestly shorter hospital stay (MD -0.40 days, 95% CI -0.78--0.02). In contrast, RHHR was associated with higher odds of cardiovascular events (OR 1.24, 95% CI 1.17-1.31), respiratory complications (OR 1.65, 95% CI 1.59-1.71), 30-day readmission (OR 1.23, 95% CI 1.19-1.27), and mortality (OR 1.26, 95% CI 1.11-1.43). No significant differences were observed for urological complications, postoperative dysphagia, or overall operative time. Certainty of evidence ranged from low to very low.
CONCLUSIONS: Comparative evidence identified through 15 July 2025 suggests broadly similar overall postoperative morbidity after RHHR and LHHR. RHHR may be associated with fewer intraoperative complications and a shorter hospital stay, but observed associations with higher odds of cardiopulmonary events, readmission, and mortality should be interpreted cautiously because the evidence is predominantly observational and susceptible to residual confounding, case-mix differences, and database-related bias.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251102047, PROSPERO identifier CRD420251102047.