机器人与腹腔镜在中下段直肠癌根治术中的应用效果比较  

Efficacy comparison of robotic and laparoscopic radical surgery in the treatment of middle-lowrectal cancer

作　　者：张海容[1] 袁维堂[1] 周全博[1] 谷晓明[1] 王福奇[1] 

机构地区：[1]郑州大学第一附属医院肛肠外科,450052

出　　处：《中华胃肠外科杂志》2017年第5期540-544,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：河南省二0一四年科技发展计划项目（142102310353）

摘　　要：目的比较机器人与腹腔镜中下段直肠癌根治术的近期临床效果。方法回顾性收集2015年1月至2016年3月间郑州大学第一附属医院肛肠外科行机器人中下段直肠癌根治术治疗的30例患者的术中及术后随访资料（机器人组），并选取同期行腹腔镜中下段直肠癌根治术的32例患者的临床资料（腹腔镜组），两组患者均为距肛缘10 cm以内的中下段进展期直肠癌患者，且经术前肠镜病理活检确诊。比较两组患者的术中及术后情况。结果机器人组中男性13例，女性17例；年龄27-85（平均数59.7）岁；病程3-12（平均数6.2）月；临床分期T2-3N 0-1。腹腔镜组中男性16例，女性16例；年龄32-79（平均数60.3）岁；病程2-10（平均数5.9）月；临床分期T2-3N 0-1。两组患者基线资料的比较，差异无统计学意义（均P 〉 0.05），具有可比性。两组患者均顺利完成手术，无中转开腹病例。与腹腔镜组比较，机器人组术中出血量更少[（100.3 ± 43.7）ml比（150.3 ± 68.2）ml，t= 3.413，P= 0.001]，首次排气时间[（49.3 ± 12.4）h比（58.6 ± 12.5）h，t= 2.838，P= 0.006]和尿管拔除时间更早[（3.0 ± 0.7）d比（4.8 ± 0.9）d，t= 5.491，P= 0.000]，但手术时间偏长[（217.3 ± 57.8）min比（187.9 ± 23.1）min，t= 2.772，P= 0.009]。两组患者手术切缘均未见癌，两组淋巴结清扫数目[（15.2 ± 7.4）枚/例比（13.9 ± 4.9）枚/例，t=-0.764，P= 0.448]、肛缘距肿瘤远端距离[（7.0 ± 3.0）cm比（6.5 ± 3.0）cm，t=-1.952，P= 0.056]及术后住院时间[（13.6 ± 1.3）d比（13.8 ± 1.8）d，t= 0.925，P= 0.359]的差异均无统计学意义。两组均无术中及术后短期严重并发症的发生。随访3-12（平均8.7）月，两组各出现1例吻合口瘘，均经保守治疗治愈，差异无统计学意义[3.3%（1/30）比3.1%（1/32），P= 1.000]；两组患者术后均无性功能障碍。随访期间，腹腔镜组出现复发转�ObjectiveTo compare the clinical efficacy of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancers.MethodsFrom January 2015 to March 2016, intra-operative and postoperative follow-up data of 30 patients with middle-low rectal cancers who underwent robotic radical resection （robot group） and 32 patients with middle-low rectal cancers who underwent laparoscopic radical resection （laparoscopy group） n in our department were retrospectively collected. The distance from cancer to anal margin was less than 10 cm in both two groups and advanced rectal cancers were confirmed by preoperative colonoscopy biopsy. Associated data were compared between two groups.ResultsThere were 13 males and 17 females in robot group with age of 27 to 85 （mean 59.7） years, disease course of 3 to 12 （mean 6.2） months and clinical stage T2-3N0-1. There were 16 males and 16 females in laparoscopic group with age of 32 to 79 （mean 60.3） years, disease course of 2 to 10 （mean 5.9） months and clinical stage T2-3N0-1. The baseline data of two groups were not significantly different （all P 〉 0.05） . All the patients in two groups completed operations successfully without conversion to open operation. Compared with laparoscopic group, the blood loss was less[ （100.3 ± 43.7） ml vs. （150.3 ± 68.2） ml, t= 3.413, P= 0.001], the first flatus time[ （49.3 ± 12.4） h vs. （58.6 ± 12.5） h, t= 2.838, P= 0.006] and urinary catheter removal time [ （3.0 ± 0.7） d vs. （4.8 ± 0.9） d, t= 5.491, P= 0.000] were shorter, while the operation time [ （217.3 ± 57.8） min vs. （187.9 ± 23.1） min, t= 2.772, P= 0.009] was longer in robot group. No cancer tissue was observed in resection margin of two groups. Number of harvested lymph node per case （15.2 ± 7.4 vs. 13.9 ± 4.9, t=-0.764, P= 0.448） , distance from anal margin to tumor distal edge[ （7 ± 3） cm vs. （6.5 ± 3） cm, t=-1.952, P= 0.056] and postoperative hospital stay [ （13.6 ± 1.3） d vs. （13.8 ± 1.8

关 键 词：机器人 腹腔镜 中下段直肠癌根治术 临床疗效 

分 类 号：R735.37[医药卫生—肿瘤]