机器人系统与腹腔镜手术在结直肠癌经自然腔道取标本手术中的效果比较  

Comparison of the curative effects of robotic system and laparoscopy on colorectal cancer via natural orifice specimen extraction surgery

作　　者：袁恩泉 徐胜 林家威[2] 黄顺荣[2] 庞黎明[2] 陈荣 周冰川[2] YUAN En-quan;XU Sheng;LIN Jia-wei(Youjiang Medical University for Nationalities,Baise 533000,China)

机构地区：[1]右江民族医学院,百色533000 [2]广西壮族自治区人民医院结直肠·肛门外科,南宁530021

出　　处：《中国临床新医学》2022年第7期594-599,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫生健康委科研课题(编号:Z20180713)

摘　　要：目的比较机器人系统和腹腔镜手术在结直肠癌经自然腔道取标本手术(NOSES)中的效果。方法回顾性分析2020年9月至2022年5月广西壮族自治区人民医院收治的36例结直肠癌患者的临床资料,包括乙状结肠癌24例,直肠癌12例。根据手术方式分为机器人组16例和腹腔镜组20例。比较两组一般情况、术中及术后情况、术后病理学结果及术后疼痛评分。结果36例患者均完成手术。两组在性别、年龄、体质量指数、术前癌胚抗原水平、肿瘤最大径等方面比较差异均无统计学意义(P>0.05)。两组在引流管放置时间、术后3 d引流总量、术后住院时间、术后并发症发生率、术后第1天粒细胞比例、术后病理肿瘤分期、神经侵犯、脉管侵犯、术后疼痛评分和住院总费用等方面比较差异无统计学意义(P>0.05)。机器人组术中出血量少于腹腔镜组,排气时间、恢复流质饮食时间短于腹腔镜组,手术时间长于腹腔镜组,术后第1天C反应蛋白水平高于腹腔镜组,标本淋巴结检出数目少于腹腔镜组,差异有统计学意义(P<0.05)。结论机器人结直肠癌NOSES是可行的,较腹腔镜结直肠癌NOSES手术具有更好的短期效果,术后胃肠道功能恢复更快,能使患者获益。Objective To compare the curative effects of robotic system and laparoscopy on colorectal cancer via natural orifice specimen extraction surgery(NOSES).Methods The clinical data of 36 patients with colorectal cancer who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from September 2020 to May 2022 were retrospectively analyzed,including 24 cases of sigmoid colon cancer and 12 cases of rectal cancer.According to different operation methods,the patients were divided into the robotic group(16 cases)and the laparoscopic group(20 cases).The general conditions,intraoperative and postoperative conditions,postoperative pathological results and postoperative pain scores were compared between the two groups.Results The operations were successfully performed on the 36 patients.There were no significant differences between the two groups in gender,age,body mass index,preoperative carcinoembryonic antigen level and maximum tumor diameter(P>0.05).There were no statistically significant differences between the two groups in drainage tube placement time,total drainage volume 3 days after operation,postoperative hospital stay,postoperative complication rate,the proportion of granulocytes on the first day after operation,postoperative pathological tumor stage,nerve invasion,vascular invasion,postoperative pain scores and hospitalization expenses(P>0.05).Compared with the laparoscopic group,the robotic group had less blood loss during operation,shorter exhaust time,shorter time to restore liquid diet,longer operation time,higher level of C-reactive protein on the first day after operation and less number of lymph nodes detected in the specimens,and the differences were statistically significant(P<0.05).Conclusion The robotic system is feasible for colorectal cancer via NOSES and may have better short-term efficacy than laparoscopic NOSES for colorectal cancer,and makes the patients′postoperative gastrointestinal function recover faster,and therefore benefits the patients.

关 键 词：结直肠癌 机器人手术系统 腹腔镜手术 经自然腔道取标本手术 微创外科 

分 类 号：R735.3[医药卫生—肿瘤]