Abstract：
OBJECTIVE: The efficacy of robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children with congenital choledochal dilatation has been a topic of much debate and controversy. The purpose of this study was to evaluate the role of RAHJ and LAHJ in pediatric congenital choledochal dilatation.
METHODS: The review program has been prospectively registered (PROSPEROID: CRD42022306868). We searched the PubMed, Embase, Cochrane, CBM, VIP, Web of Science, CNKI databases, and Wanfang databases from March 2021. The Mantel-Haenszel method and a random-effects model were used to figure out the hazard ratio (95% CI).
RESULTS: Ten studies evaluated eight hundred and sixty-nine subjects (three hundred and thirty-two in the robotic group and five hundred and thirty-seven in the laparoscopic group), meeting all inclusion criteria. Compared with the laparoscopic group, robotic group demonstrated fewer postoperative complications [p = 0.0009; OR = 0.34 (95% CI, 0.18-0.64); I2 = 3%], shorter postoperative hospital stay [p < 00,001; MD = - 2.05 (95% CI, - 2.40-1.70); I2 = 0%], and less intraoperative bleeding [p = 0.008; MD = - 10.80 (95% CI, - 18.80-2.81); I2 = 99%]. There was no significant difference in operative time between the two groups [p = 0.10; MD = 24.53 (95% CI, - 5.11-54.17); I2 = 99%]. The same situation happened in short-term complication outcomes [p = 0.06; RR = 0.45 (95% CI, 0.19-1.04); I2 = 0%]. However, children in the RAHJ group had significantly lower levels of long-term complications [p = 0.04; OR = 0.41 (95% CI, 0.17-0.96); I2 = 0%]. Hospitalization costs were significantly higher in the RAHJ group [p < 0.00001; OR = 27,113.86 (95% CI, 26,307.24-27,920.48); I2 = 0%]. For overall complications, subgroup analysis of literature published after 2020 and of literature with high quality scores showed a significant decrease in the RAHJ group.
CONCLUSIONS: In children with congenital choledochal dilatation, RAHJ is associated with reduced intraoperative bleeding, postoperative complications, and length of stay. Robotic surgery has a bright future in the treatment of pediatric common hepatic duct cysts and deserves to be promoted and popularized.
METHODS: The review program has been prospectively registered (PROSPEROID: CRD42022306868). We searched the PubMed, Embase, Cochrane, CBM, VIP, Web of Science, CNKI databases, and Wanfang databases from March 2021. The Mantel-Haenszel method and a random-effects model were used to figure out the hazard ratio (95% CI).
RESULTS: Ten studies evaluated eight hundred and sixty-nine subjects (three hundred and thirty-two in the robotic group and five hundred and thirty-seven in the laparoscopic group), meeting all inclusion criteria. Compared with the laparoscopic group, robotic group demonstrated fewer postoperative complications [p = 0.0009; OR = 0.34 (95% CI, 0.18-0.64); I2 = 3%], shorter postoperative hospital stay [p < 00,001; MD = - 2.05 (95% CI, - 2.40-1.70); I2 = 0%], and less intraoperative bleeding [p = 0.008; MD = - 10.80 (95% CI, - 18.80-2.81); I2 = 99%]. There was no significant difference in operative time between the two groups [p = 0.10; MD = 24.53 (95% CI, - 5.11-54.17); I2 = 99%]. The same situation happened in short-term complication outcomes [p = 0.06; RR = 0.45 (95% CI, 0.19-1.04); I2 = 0%]. However, children in the RAHJ group had significantly lower levels of long-term complications [p = 0.04; OR = 0.41 (95% CI, 0.17-0.96); I2 = 0%]. Hospitalization costs were significantly higher in the RAHJ group [p < 0.00001; OR = 27,113.86 (95% CI, 26,307.24-27,920.48); I2 = 0%]. For overall complications, subgroup analysis of literature published after 2020 and of literature with high quality scores showed a significant decrease in the RAHJ group.
CONCLUSIONS: In children with congenital choledochal dilatation, RAHJ is associated with reduced intraoperative bleeding, postoperative complications, and length of stay. Robotic surgery has a bright future in the treatment of pediatric common hepatic duct cysts and deserves to be promoted and popularized.
摘要：
目的：机器人辅助肝空肠吻合术（RAHJ）和腹腔镜辅助肝空肠吻合术（LAHJ）在先天性胆总管扩张患儿中的疗效一直是一个备受争议的话题。目的评价RAHJ和LAHJ在小儿先天性胆总管扩张中的作用。
方法：审查计划已前瞻性注册（PROSPEROID：CRD42022306868）。我们搜查了PubMed,Embase,科克伦,CBM,VIP,WebofScience,CNKI数据库，和万方数据库从2021年3月开始。使用Mantel-Haenszel方法和随机效应模型来计算风险比(95%CI)。
结果：10项研究评估了八百六十九名受试者（机器人组三百三十二名，腹腔镜组五百三十七名），符合所有纳入标准。与腹腔镜组相比，机器人组术后并发症较少[p=0.0009;OR=0.34(95%CI,0.18-0.64);I2=3%],术后住院时间较短[p<00,001；MD=-2.05（95%CI，-2.40-1.70）；I2=0%]，术中出血较少[p=0.008;MD=-10.80(95%CI,-18.80-2.81);I2=99%]。两组之间的手术时间没有显着差异[p=0.10；MD=24.53（95％CI，-5.11-54.17）；I2=99％]。短期并发症结果也是如此[p=0.06;RR=0.45(95%CI,0.19-1.04);I2=0%]。然而,RAHJ组儿童的长期并发症水平显著较低[p=0.04;OR=0.41(95%CI,0.17~0.96);I2=0%].RAHJ组的住院费用明显较高[p<0.00001;OR=27,113.86(95%CI,26,307.24-27,920.48);I2=0%]。对于整体并发症，对2020年后发表的文献和高质量评分文献的亚组分析显示,RAHJ组显著下降.
结论：在先天性胆总管扩张的儿童中，RAHJ与术中出血减少有关，术后并发症,和逗留时间的长短。机器人手术在小儿肝胆管囊肿的治疗中具有广阔的前景，值得推广和推广。
方法：审查计划已前瞻性注册（PROSPEROID：CRD42022306868）。我们搜查了PubMed,Embase,科克伦,CBM,VIP,WebofScience,CNKI数据库，和万方数据库从2021年3月开始。使用Mantel-Haenszel方法和随机效应模型来计算风险比(95%CI)。
结果：10项研究评估了八百六十九名受试者（机器人组三百三十二名，腹腔镜组五百三十七名），符合所有纳入标准。与腹腔镜组相比，机器人组术后并发症较少[p=0.0009;OR=0.34(95%CI,0.18-0.64);I2=3%],术后住院时间较短[p<00,001；MD=-2.05（95%CI，-2.40-1.70）；I2=0%]，术中出血较少[p=0.008;MD=-10.80(95%CI,-18.80-2.81);I2=99%]。两组之间的手术时间没有显着差异[p=0.10；MD=24.53（95％CI，-5.11-54.17）；I2=99％]。短期并发症结果也是如此[p=0.06;RR=0.45(95%CI,0.19-1.04);I2=0%]。然而,RAHJ组儿童的长期并发症水平显著较低[p=0.04;OR=0.41(95%CI,0.17~0.96);I2=0%].RAHJ组的住院费用明显较高[p<0.00001;OR=27,113.86(95%CI,26,307.24-27,920.48);I2=0%]。对于整体并发症，对2020年后发表的文献和高质量评分文献的亚组分析显示,RAHJ组显著下降.
结论：在先天性胆总管扩张的儿童中，RAHJ与术中出血减少有关，术后并发症,和逗留时间的长短。机器人手术在小儿肝胆管囊肿的治疗中具有广阔的前景，值得推广和推广。
