达芬奇机器人手术系统与腹腔镜全直肠系膜切除术治疗低位直肠癌的疗效分析  

Efficacy analysis of Da Vinci robotic and laparoscopic total mesorectal excision for low rectal cancer

作　　者：徐舟舟 朱晒红[1] 易波[1] 李俊 李嘉柯 吴树荣 Xu Zhouzhou;Zhu Shaihong;Yi Bo;Li Jun;Li Jiake;Wu Shurong(The Second Ward of Department of Gastrointestinal Surgery,the Third Xiangya Hospital of Central South University,Changsha 410006,China)

机构地区：[1]中南大学湘雅三医院胃肠外二科,长沙410006

出　　处：《中华消化外科杂志》2020年第5期537-543,共7页Chinese Journal of Digestive Surgery

基　　金：国家重点研发项目(2017YFC0110402)。

摘　　要：目的:比较达芬奇机器人手术系统与腹腔镜全直肠系膜切除术(TME)治疗低位直肠癌的临床疗效。方法:采用回顾性队列研究方法。收集2015年10月至2019年1月中南大学湘雅三医院收治的64例低位直肠癌患者的临床病理资料;男42例,女22例;中位年龄为59岁,年龄范围为40~84岁。64例患者中,31例行达芬奇机器人手术系统TME设为机器人组,33例行腹腔镜TME设为腹腔镜组。观察指标:(1)手术及术后恢复情况。(2)术后病理学检查情况。(3)随访情况。采用门诊或电话方式进行随访,了解患者长期并发症及盆腔植物神经损伤情况。随访时间截至2020年1月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(P25,P75)表示,组间比较采用秩和检验。计数资料以绝对数表示,组间比较采用χ^2检验或Fisher确切概率法。等级资料组间比较采用Mann-Whitney U检验。结果:(1)手术及术后恢复情况:机器人组患者保肛例数、预防性造口例数、中转开腹例数、术中输血例数、手术时间、术中出血量、术后首次下床活动时间、术后首次肛门排气时间、术后恢复饮食时间、住院时间、伤口感染、术后出血、吻合口瘘、肺部感染、尿潴留、全组患者并发症综合指数、并发症患者并发症综合指数、治疗费用分别为30例、23例、0、1例、(285±73)min、(147±112)mL、(1.6±0.8)d、(3.6±1.1)d、(3.2±1.5)d、(9.8±2.8)d、1例、4例、3例、1例、4例、(15.0±12.0)分、22.6分(20.9分,27.3分)、(11.7±1.2)万元。腹腔镜组患者上述指标分别为22例、13例、2例、2例、(253±57)min、(211±123)mL、(1.8±0.8)d、(3.9±1.6)d、(4.1±1.9)d、(11.8±4.3)d、2例、5例、3例、3例、2例、(20.0±12.0)分、24.2分(10.5分,30.8分)、(7.7±1.3)万元。两组患者保肛例数、术中出血量、住院时间、治疗费用比较,差异均有统计学意义(χ^2=8.581,t=-2.065,-2.133,12.700,P<0.05);两Objective:To compare the clinical efficacies of Da Vinci robotic and laparoscopic total mesorectal excision(TME)for low rectal cancer.Methods:The retrospective cohort study was conducted.The clinicopathological data of 64 patients with low rectal cancer who were admitted to the Third Xiangya Hospital of Central South University from October 2015 to January 2019 were collected.There were 42 males and 22 females,aged from 40 to 84 years,with a median age of 59 years.Of the 64 patients,31 undergoing Da Vinci robotic TME and 33 undergoing laparoscopic TME were allocated into robotic group and laparoscopic group,respectively.Observation indicators:(1)surgical situations and postoperative recovery;(2)postoperative pathological examination;(3)follow-up.Follow-up using outpatient examination and telephone interview was conducted to detect long-term complications and pelvic autonomic nerve injury up to January 2020.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(P25,P75),and comparison between groups was analyzed using the rank sum test.Count data were represented as absolute numbers,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.Results:(1)Surgical situations and postoperative recovery:cases with anus preservation,cases with defunctioning stoma,cases with intraoperative conversion to laparotomy,cases with intraoperative blood transfusion,operation time,volume of intraoperative blood loss,time to postoperative first out-of-bed activities,time to postoperative first flatus,time to postoperative diet resumption,duration of hospital stay,cases with incision infection,cases with postoperative hemorrhage,cases with anastomotic fistula,cases with pulmonary infection,cases with urinary retention,comprehensive complication index for the whole group,comp

关 键 词：直肠肿瘤 低位直肠癌 达芬奇机器人手术系统 腹腔镜检查 肛门括约肌保留率 盆腔植物神经 

分 类 号：R735.37[医药卫生—肿瘤]