目的：通过 Meta 分析对比机器人辅助下经自然腔道标本取出手术（Natural Orifice Specimen Extraction  Surgery，NOSES）与常规机器人辅助手术治疗结直肠癌的临床疗效。方法：检索截至 2021 年 12 月公开发表的机器人 辅助经自然腔道取出标本的结直肠癌根治术对比常规机器人辅助手术治疗结直肠癌的研究。根据原始文献的纳入标 准、排除标准对检索文献进行相关筛选，对纳入文献进行质量评价，获得最终纳入分析的文献。提取纳入文献的相 关数据，采用 RevMan5.3 统计学软件进行分析。结果：最终纳入 8 篇文献，其中 1 篇随机对照研究，7 篇回顾性研究， 共涉及 701 例患者，其中行机器人辅助下经自然腔道标本取出手术（NOSES 组）338 例，行常规机器人辅助手术（常 规机器人组）363 例。Meta 分析结果显示，NOSES 组手术时间比常规机器人组更长（WMD=7.69，95%CI=1.89~13.50， P=0.009），差异有统计学意义。两组术中出血量相比，NOSES 组术中出血量高于常规机器人组（WMD=-4.93， 95%CI=-9.32~-0.53，P=0.03）；两组切除的肿瘤大小比较，差异无统计学意义（WMD=-0.09，95%CI=-0.26~0.08， P=0.30）；两组淋巴结清扫数目比较，差异无统计学意义（WMD=-0.32，95%CI=-0.85~0.21，P=0.24）；两组术后 腹腔冲洗液细菌学检测结果比较，差异无统计学意义（OR=1.42，95%CI=0.56~3.62，P=0.46）。与常规机器人组相 比，NOSES 组术后 VAS 评分更低（WMD=-1.14，95%CI=-1.55~-0.74，P<0.001），术后附加镇痛更少（OR=0.22， 95%CI=0.13~0.38，P<0.001），术后血常规 WBC 水平更低（WMD=-0.99，95%CI=-1.44~-0.54，P<0.001），术后首 次排气时间更早（WMD=-11.36，95%CI=-14.70~-8.02，P<0.001），术后首次进食时间更早（WMD=-9.13，95%CI= -11.49~-6.78，P<0.001），术后总并发症更少（OR=0.57，95%CI=0.35~0.92，P=0.02），切口感染率更低（OR=0.20， 95%CI=0.06~0.83，P=0.006），差异有统计学意义。两组吻合口瘘发生率（OR=1.35，95%CI=0.58~3.14，P=0.49）、 腹腔内感染发生率（OR=1.26，95%CI=0.36~4.42，P=0.72）和肠梗阻发生率（OR=0.68，95%CI=0.19~2.43，P=0.56） 比 较， 差 异 无 统 计 学 意 义。NOSES 组 术 后 住 院 时 间 比 常 规 机 器 人 组 更 短（WMD=-1.21，95%CI=-2.08~-0.34， P=0.006），差异有统计学意义。结论：与传统机器人辅助手术相比，机器人辅助下经自然腔道标本取出手术可以减轻 术后疼痛，减小附加镇痛比例，降低机体应激反应，降低术后总并发症发生率，更快恢复胃肠道功能。

Objective: To compare the clinical efficacy of robot-assisted natural orifice specimen extraction surgery  (NOSES) and conventional robot-assisted surgery in the treatment of colorectal cancer by Meta-analysis. Methods: To retrieve  studies on the comparison of robot-assisted radical resection of colorectal cancer with NOSES approach and conventional  robot-assisted surgery in treating colorectal cancer before December 2021. The retrieved studies were screened according  to certain inclusion and exclusion criteria, and the quality of included literature was evaluated to obtain the qualified  literatures for analysis. The relevant data of the included literatures were extracted, and RevMan5.3 was used for statistical  analysis. Results: Finally, 8 articles were included, including 1 randomized controlled study and 7 retrospective studies.  701 patients were involved in the 8 studies, including 338 robot-assisted natural orifice specimen extraction surgery (NOSES  group) and 363 conventional robot-assisted surgeries (conventional robotic group). The meta-analysis result showed that  the operative time in the NOSES group was longer than that in the conventional robotic group (WMD=7.69, 95%CI=1.89  to 13.50, P=0.009), the intraoperative blood loss of the NOSES group was higher than that of the conventional robtic group  (WMD=-4.93, 95%CI= -9.32 to 0.53, P=0.03), the size of resected tumors (WMD=-0.09, 95%CI= -0.26 to 0.08, P=0.30),  the number of lymph node dissection (WMD=-0.32, 95%CI=-0.85 to 0.21, P=0.24) or the microbiological detection results  on peritoneal washings after surgery (OR=1.42, 95%CI= 0.56 to 3.62, P=0.46) were found between the two groups. The  postoperative VAS score in the NOSES group was lower than that in the conventional robotic group (WMD=-1.14, 95%CI= -1.55 to -0.74, P<0.001). The postoperative added analgesia was less in the NOSES group than in the conventional robot  group (OR=0.22, 95%CI= 0.13 to 0.38, P<0.001). The level WBC after surgery of NOSES group was lower than that in  conventional robotic group (WMD=-0.99, 95%CI= -1.44 to -0.54, P<0.001). The first exhaust time after surgery in the  NOSES group was earlier than that in the conventional robotic group (WMD=-11.36, 95%CI= -14.70 to -8.02, P<0.001).  The first feeding time after surgery in the NOSES group was earlier than that in the conventional robotic group (WMD=-9.13,  95%CI=-11.49 to -6.78, P<0.001). The total postoperative complications were less in the NOSES group than the conventional  robotic group (OR=0.57, 95%CI=0.35 to 0.92, P=0.02). The NOSES group had lower surgical sites infection rate than the  conventional robotic group (OR=0.20, 95%CI=0.06 to 0.83, P=0.006). There was no significant difference in the incidence  of anastomotic fistula (OR=1.35, 95%CI=0.58 to 3.14, P=0.49), the intraperitoneal infection (OR=1.26, 95%CI=0.36 to  4.42, P=0.72), or occurrence of intestinal obstruction (OR=0.68, 95%CI=0.19 to 2.43, P=0.56) between the two groups. The  postoperative hospital stay in the NOSES group was shorter than that in the conventional robotic group (WMD=-1.21, 95%CI= -2.08 to -0.34, P=0.006). Conclusion: Compared with the conventional robot-assisted surgery, robot-assisted NOSES could  reduce postoperative pain, lower the proportion of additional analgesia, relieve the body stress response, decrease the incidence  of postoperative complications, and enhance recovery of gastrointestinal function.

收稿日期：2022-08-05  录用日期：2022-12-16 

Received Date: 2022-08-05  Accepted Date: 2022-12-16 

基金项目：甘肃省肛肠疾病临床医学研究中心建设项目（20JR10RA434） 

Foundation Item: Construction Project of Clinical Research Center for Anorectal Diseases in Gansu province(20JR10RA434) 

通讯作者：杨熊飞，Email：XiongfeiYang2022@163.com 

Corresponding Author: YANG Xiongfei, Email: XiongfeiYang2022@163.com 

引用格式：王帅，路继永，张成仁，等 . 机器人辅助下经自然腔道标本取出手术与常规机器人辅助手术治疗结直肠癌疗效的 Meta 分析 [J]. 机器人外科学杂志（中英文），2023，4（4）：320-332. 

Citation: WANG S, LU J Y, ZHANG C R, et al. Clinical efficacy of robot-assisted natural orifice specimen extraction surgery and conventional robot-assisted surgery for colorectal cancer: a Meta-analysis [J]. Chinese Journal of Robotic Surgery, 2023, 4(4): 320-332.

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