达芬奇与妙手机器人系统辅助直肠癌直肠全系膜切除短期疗效比较研究  

Comparison of robot-assisted total mesorectal excision for rectal cancer with da Vinci versus Micro Hand S surgical system

作　　者：易波[1] 雷阳 张皓 谢京茂 刘毅辉 王国慧[1] 李政[1] 曾一家 朱晒红[1] YI Bo;LEI Yang;ZHANG Hao(Department of Bariatric and Metabolic Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院普外科,湖南长沙424500

出　　处：《中国实用外科杂志》2021年第12期1410-1418,共9页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.51875580);湖南省重点领域研发计划(No.2021SK2001)。

摘　　要：目的对比妙手机器人系统(Micro Hand S)与达芬奇手术机器人系统在机器人辅助直肠全系膜切除(R-TME)的短期疗效,探讨Micro Hand S在R-TME中的临床应用价值。方法2017年5月至2018年12月期间,中南大学湘雅三医院前瞻性纳入连续68例接受直肠癌的病人,均接受了Micro Hand S或达芬奇手术机器人的RTME治疗。主要评价结果为直肠全系膜切除(TME)标本的完整性。次要评价结果是环周切缘(CRM)和远端切缘(DRM)、清扫淋巴结数目、术中失血量、手术时间、手术中转率、综合并发症指数(CCI)、术后泌尿功能国际前列腺症状评分(IPSS)和大便失禁程度Wexner评分。结果37例病人接受了达芬奇手术机器人R-TME治疗,31例病人接受了Micro Hand S R-TME治疗。两组之间的TME完整性差异无统计学意义(完全TME加几乎完全TME,分别为93.5%和94.6%,P=0.944)。年龄、性别、体重指数(BMI)、肿瘤分期、手术时间、失血率、VAS评分、GOALS评分、转化率、CRM、CRM阳性率、DRM、DRM阳性率、淋巴结数目、CCI、IPSS或Wexner评分差异均无统计学意义。Micro Hand S手术机器人的装机时间较达芬奇手术机器人中位装机时间明显延长[23(15~40)min vs.15(10~40)min,P=0.001]。结论da Vinci、Micro Hand S手术机器人在R-TME中的临床应用是安全且有效的。Objective To evaluate the efficacy of robot-assisted total mesorectal excision(R-TME)using a domestically developed Chinese surgical robot system compared with that of da Vinci R-TME using a short-term evaluation.Methods From May 2017 to June 2018,68 consecutive patients with rectal cancer who underwent R-TME with the Micro Hand S or da Vinci surgical system in the Third Xiangya Hospital of Central South University were prospectively enrolled.The primary outcome was the completeness of the TME specimen.Secondary outcomes were the circumferential and distal resection margin(CRM and DRM),number of retrieved lymph nodes,blood loss,operative time(OT),conversion rate,comprehensive complication index(CCI),IPSS or Wexner scores.Results Thirty-seven patients underwent da Vinci R-TME,and 31 patients underwent Micro Hand S R-TME.There was no significant difference in TME between the two groups(complete TME and nearly complete TME,93.5%vs 94.6%,P=0.944).There was no statistically significant difference in age,sex,BMI,tumor stage,OT,blood loss,conversion rate,CRM,positive CRM rate,number of retrieved lymph nodes,CCI,IPSS or Wexner scores.The setup time was significantly longer in the Micro Hand S group[23(15~40)vs.15(10~40)mins,P=0.001].Conclusion R-TME using the da Vinci or Micro Hand S surgical system for selected rectal cancer patients is technically feasible and safe.

关 键 词：机器人辅助直肠全系膜切除术 达芬奇手术机器人系统 Micro Hand S手术机器人系统 直肠癌 

分 类 号：R6[医药卫生—外科学]