机器人与腹腔镜直肠癌全系膜切除术短期疗效对比分析  

Oncologic and short-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a cohort study

作　　者：刘文涵 闫沛静 胡东平[2] 杜斌斌[2] 朱小龙 杨熊飞[2] LIU Wenhan;YAN Peijing;HU Dongping;DU Binbin;ZHU Xiaolong;YANG Xiongfei(Department of Clinical Medicine,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,P.R.China;Department of Colorectal Surgery,Gansu Provincial Hospital,Lanzhou 730000,P.R.China;Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,P.R.China;Institution of Clinical Research and Evidence Based Medicine,Gansu Provincial Hospital,Lanzhou 730000,P.R.China)

机构地区：[1]甘肃中医药大学临床医学研究生院,兰州730000 [2]甘肃省人民医院肛肠科,兰州730000 [3]兰州大学循证医学中心,兰州730000 [4]甘肃省人民医院临床循证医学研究院,兰州730000

出　　处：《中国普外基础与临床杂志》2019年第1期31-37,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：甘肃省人民医院院内科研基金(项目编号:16GSSY1-9)

摘　　要：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) d vs.(6.28±2.74) d, P<0.001)and the length of hospital stay [(11.20±5.80)d vs.(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) CNY vs.(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 

分 类 号：R735.37[医药卫生—肿瘤]