机器人和腹腔镜及开腹手术治疗重度直肠脱垂的临床效果比较  

Comparison of clinical efficacy of robotic,laparoscopic and open surgery in the treatment of severe rectal prolapse

作　　者：李震[1] 王世豪 李国宾[1] 连玉贵 谷晓明[1] 夏坤锟[1] 袁维堂[1] Li Zhen;Wang Shihao;Li Guobin;Lian Yugui;Gu Xiaoming;Xia Kunkun;Yuan Weitang(Department of Colorectal and Anal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科,450052

出　　处：《中华胃肠外科杂志》2020年第12期1187-1193,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金青年项目(81903694);河南省卫生计生科技英才海外研修工程(2018039)。

摘　　要：目的分析对比机器人、腹腔镜及开腹经直肠后补片悬吊固定术在重度直肠脱垂治疗中疗效的差别。方法采用回顾性队列研究方法。纳入术前直肠全层拖出肛门且长度>8 cm、并行经腹直肠后补片悬吊固定术者。排除术前有排尿或性功能障碍者、无固定性伴侣或术后无性活动而无法进行性功能评分者、围手术期内再次行开腹手术者、行机器人或腹腔镜手术时中转开腹者以及资料不完整者。2014—2018年期间在郑州大学第一附属医院治疗的重度直肠脱垂患者61例被纳入本研究。根据患者意愿选择手术方式,其中21例采用传统开腹手术(开腹组),20例采用腹腔镜手术(腹腔镜组),20例采用机器人手术(机器人组)。比较3组间的围手术期相关指标,并采用国际前列腺症状评分表(IPSS;评分越高,说明排尿功能障碍越严重)、改良国际勃起功能问卷(IIEF⁃15;分值越低,说明男性性功能障碍越严重)以及女性性功能指数(FSFI⁃19;分值越低,说明女性性功能障碍越严重),对患者手术前后的排尿功能和性功能进行评分和比较。结果3组患者基线资料的比较,差异均无统计学意义(均P>0.05),具有可比性。机器人组、腹腔镜组和开腹组手术时间分别为(176.3±13.8)min、(160.2±12.1)min及(134.2±12.1)min;术中出血量分别为(58.5±18.9)ml、(67.9±15.7)ml及(114.2±8.4)ml;首次下床时间分别为(19.9±6.8)h、(24.0±8.9)h及(37.7±11.4)h;首次排气时间分别为(31.8±6.8)h、(35.7±8.9)h及(49.2±11.2)h;住院时间分别为(11.0±1.4)d、(11.4±1.4)d及(13.3±2.1)d;3组间比较,差异均有统计学意义(均P<0.001)。3组间并发症的发生以及术后复发情况的差异均无统计学意义(均P>0.05)。机器人组、腹腔镜组及开腹组患者术前IPSS评分分别为(4.2±1.7)分、(4.4±1.3)分和(4.7±1.8)分;术后3个月分别为(8.5±2.5)分、(9.9±1.7)分和(12.2±3.1)分;术后12个月分别为(4.3±1.6)分、(5.8±1.3Objective To analyze and compare the efficacy of robotic,laparoscopic and open dorsal mesh rectopexy in the treatment of severe rectal prolapse.Methods A retrospective cohort study was performed.Patients who had a full⁃thickness rectum pulled out of the anus before surgery and the length was greater than 8 cm,and underwent transabdominal dorsal mesh rectopexy were enrolled in the study.Those who had urinary or sexual dysfunction before surgery,could not perform sexual function scores due to lack of a fixed sexual partner or sexual activity after surgery,underwent laparotomy again during the perioperative period,were transferred to laparotomy during robotic or laparoscopic surgery,or had no complete information,were excluded.A total of 61 patients with severe rectal prolapse in the First Affiliated Hospital of Zhengzhou University from 2014 to 2018 were enrolled and divided into robotic group(20 cases),laparoscopic group(20 cases)and open group(21 cases)according to the operative procedure based on patients'will.Perioperative parameters were compared among the 3 groups.The International Prostatic Symptoms Score Scale(IPSS,higher score indicates more severe urinary dysfunction),the International Index of Erectile Function questionnaire(IIEF⁃15,lower score indicates more severe male sexual dysfunction)and the Female Sexual Function Index(FSFI⁃19,lower score indicates more severe female sexual dysfunction)were used to evaluate and compare the urinary and sexual function before and after operation.Results There were no significant differences in baseline data among the 3 groups(all P>0.05).In the robotic,laparoscopic and open groups respectively,the operative time was(176.3±13.8)minutes,(160.2±12.1)minutes and(134.2±12.1)minutes;intraoperative blood loss was(58.5±18.9)ml,(67.9±15.7)ml and(114.2±8.4)ml;the first time to ambulation was(19.9±6.8)hours,(24.0±8.9)hours and(37.7±11.4)hours;the first time to gas passage was(31.8±6.8)hours,(35.7±8.9)hours and(49.2±11.2)hours;the hospitalization time was(11.0

关 键 词：重度直肠脱垂 机器人手术 腹腔镜手术 开腹手术 盆腔自主神经保护 排尿及性功能 

分 类 号：R657.19[医药卫生—外科学]