中国普外基础与临床杂志

中国普外基础与临床杂志

机器人与腹腔镜直肠癌全系膜切除术短期疗效对比分析

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目的 对比机器人与腹腔镜直肠全系膜切除术的肿瘤根治效果和短期疗效。 方法 回顾性收集 2015 年 7 月至 2017 年 10 月期间于笔者所在医院肛肠科接受机器人直肠全系膜切除术患者 80 例,以及同期同一术者实施、病理分期相同的腹腔镜直肠全系膜切除术患者 116 例,采用队列研究方法分析两种手术方式的肿瘤根治效果及其短期疗效。 结果 机器人组术后住院时间 [(11.20±5.80)d 比 (14.72±6.90) d,P=0.023],首次肛门排气时间 [(3.28±1.64)d 比(6.01±2.77)d,P<0.001] 和首次进流质饮食时间 [(4.46±1.62)d 比(6.28±2.74) d,P<0.001] 均比腹腔镜组缩短近 3 d;术后尿潴留的发生率(2.50% 比 7.76%,P=0.016)机器人组明显低于腹腔镜组;但机器人组术中出血量较腹腔镜组多 [(175.06±110.77) mL 比(123.91±99.61)mL,P=0.031];2 组的手术时间、淋巴结清扫数目、肿瘤下缘距下切缘距离和其他术后并发症发生率比较差异无统计学意义(P>0.05); 2 组总费用的比较,机器人组总费用虽高于腹腔镜组,但差异无统计学意义 [(85 623.91±13 310.50)元 比(67 356.79±17 107.68)元,P=0.084]。 结论 机器人直肠全系膜切除术与腹腔镜手术相比,具有相同的肿瘤根治效果和较快的术后短期恢复。机器人直肠全系膜切除术的远期疗效有待进一步观察。

Objective To compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision (R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision (L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus [(3.28±1.64) d vs. (6.01±2.77) d,P<0.001], the time to the first postoperative oral fluid intake [(4.46±1.62) dvs. (6.28±2.74) d,P<0.001) and the length of hospital stay [(11.20±5.80)dvs. (14.72±6.90) d,P=0.023] of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention (2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group [(175.06±110.77) mL vs. (123.91±99.61) mL, P=0.031, ). The operative time, number of lymph nodes harvested and distal margin were similar intergroup(P>0.05). The total cost was higher in the R-TME than in the L-TME group [(85 623.91±13 310.50) CNYvs. (67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. Conclusions Compared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.

关键词: 机器人; 腹腔镜; 直肠全系膜切除术; 微创外科; 肿瘤根治效果; 术后短期疗效

Key words: Robotic; Laparoscopic; total mesorectal excision; minimal invasive; oncologic outcomes; postoperative short-term outcomes

引用本文: 刘文涵, 闫沛静, 胡东平, 杜斌斌, 朱小龙, 杨熊飞. 机器人与腹腔镜直肠癌全系膜切除术短期疗效对比分析. 中国普外基础与临床杂志, 2019, 26(1): 31-37. doi: 10.7507/1007-9424.201809031 复制

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