“机器人”结直肠肿瘤经自然腔道取标本手术回顾性分析:一项全国多中心研究  

Robotic natural orifice specimen extraction surgery of colorectal neoplasms in China:A nationwide muticenter analysis

作　　者：刘东宁[1] 何国栋 姚宏亮[3] 王锡山 王贵玉[5] 熊德海 佘军军 胡军红 袁维堂[8] 杨春康[9] 蔡建春[10] 韩方海[11] 曾祥福[12] 何鹏辉[1] 叶善平 牛正川 刘奎杰[3] 关旭 汤庆超[5] 黄睿[5] 时飞宇 连玉贵 官申[9] 简锦亮 王振发[10] 周声宁 赵书锋 韦烨 李太原[1] Dongning Liu;Guodong He;Hongliang Yao;Xishan Wang;Guiyu Wang;Dehai Xiong;Junjun She;Junhong Hu;Weitang Yuan;Chunkang Yang;Jianchun Cai;Fanghai Han;Xiangfu Zeng;Penghui He;Shanping Ye;Zhengchuan Niu;Kuijie Liu;Xu Guan;Qingchao Tang;Rui Huang;Feiyu Shi;Yugui Lian;Shen Guan;Jinliang Jian;Zhenfa Wang;Shenning Zhou;Shufeng Zhao;Ye Wei;Taiyuan Li(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032 China;Department of Gastrointestinal Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Colorectal Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Colorectal Cancer,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Gastrointestinal Surgery,Chongqing Three Gorges Central Hospital,Wanzhou 404000,China;Department of General Surgery,First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China;Department of Colorectal and Anal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Gastrointestinal Surgical Oncology,Fujian Tumor Hospital,Fuzhou 350014,China;Department of Gastrointestinal Surgery,Zhongshan Hospital of Xiamen University,Xiamen 361004,China;Department of Gastrointestinal Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Gastrointestinal Surgery,First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]南昌大学第一附属医院普外科,南昌330006 [2]复旦大学附属中山医院普外科,上海200032 [3]中南大学湘雅二医院胃肠外科,长沙410011 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [5]哈尔滨医科大学附属第二医院结直肠肿瘤外科,哈尔滨150086 [6]重庆大学附属三峡医院肠道(疝与腹壁)外科,万州404000 [7]西安交通大学第一附属医院普通外科,710061 [8]郑州大学第一附属医院结直肠肛门外科,450000 [9]福建省肿瘤医院胃肠肿瘤外科,福州350014 [10]厦门大学附属中山医院胃肠外科,361004 [11]中山大学孙逸仙纪念医院胃肠外科,广州510120 [12]赣南医学院第一附属医院胃肠外科,赣州341000

出　　处：《中华结直肠疾病电子杂志》2022年第6期474-481,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨“机器人”结直肠肿瘤经自然腔道取标本手术(R-CRC-NOSES)的可行性和安全性。方法采用描述性病例系列研究方法。纳入2013年3月至2022年3月期间全国12家医院的R-CRC-NOSES病例。回顾性收集患者一般资料、肿瘤根治性资料(淋巴结检出数、转移阳性淋巴结数以及阳性切缘情况等)和手术安全性资料(手术时间、术中出血量以及术后并发症情况等)。结果本研究共纳入有效病例983例。平均年龄(61.5±9.6)岁,平均BMI(22.8±6.7)kg/m^(2),4.8%的病例接受术前新辅助治疗,77.1%的病例采用经直肠取标本。肿瘤根治性资料显示:最大环周直径3 cm~5 cm比例占病例总数的64.1%,管状腺癌比例占病例总数的85.6%,T3和T4期比例占总病例数的76.2%,68.2%的病例检出淋巴结数目≥12枚,28.9%的病例有淋巴结转移;Ⅰ~Ⅲ期病例分别占5.6%,29.7%和64.7%,无环周切缘阳性。手术安全性资料显示:无中转开腹病例,平均手术时间为(172.9±55.2)min,平均术中出血量为(46.3±20.3)mL,平均术后首次排气时间(47.5±12.0)h,平均术后进食时间为(73.5±12.8)h,平均术后住院时间为(8.2±2.5)d,术后并发症总发生率为14.1%,非计划再手术比例为1.7%,围手术期无死亡病例,术后肛门功能障碍者占总数的1.3%,未发现阴道功能障碍者。结论R-CRC-NOSES具有良好的可行性和安全性,值得临床广泛推广应用。ObjectiveTo assess the efficacy and safety of robotic natural orifice specimen extraction surgery (R-CRC-NOSES).MethodsThis descriptive case-series study identified patients who underwent R-CRC-NOSES from March 2013 to March 2022 in 12 tertiary hospitals in China. Data on patient characteristics, surgery characteristics, and oncology-related surgery outcomes were analyzed.ResultsA total of 983 patients were identified. Age at surgery were (61.5±9.6) years. Body mass index were(22.8±6.7)kg/m^(2). 4.8% of the patients received neoadjuvant chemoradiotherapy. 77.1% of the patients underwent rectal specimen extraction. Regarding oncology-related surgery outcomes, 64.1% patients had tumors 3 cm~5 cm in diameter;adenocarcinoma makes up of 85.6% of the study population;76.2% patients had T3/T4 disease;the proportion of harvested lymph nodes ≥12 was 68.2% while 28.9% patients had positive lymph node;stage I~Ⅲ disease were 5.6%, 29.7% and 64.7%, respectively;none of the patients had positive circumferential margins. Surgery characteristics are as follows: no patients transferred to open surgery, surgery time was (172.9±55.2) min;intraoperative bleeding was (46.3±20.3) mL;time to first flatus postoperative was (47.5±12.0) hours;time to first postoperative fluid diet was (73.5±12.8) hours;hospitalization time was (8.2±2.5) days with an overall complication rate of 14.1% and a reoperation rate of 1.7%;no death occurred;1.3% patients developed anal disorders and vaginal dysfunction was not observed.ConclusionR-CRC-NOSES has favourable efficacy and safety suggesting an alternative surgery modality.

关 键 词：结直肠肿瘤 经自然腔道取标本手术(NOSES) 机器人手术 回顾性分析 

分 类 号：R735.34[医药卫生—肿瘤]