机器人与腹腔镜肝切除手术短期疗效及安全性对比研究  

Comparison of short-term efficacy and safety between robotic and laparoscopic hepatectomy

作　　者：周永志 杨广超 李中宇 孟展志 王明远 李林强[1] 宋宣[1] 麻勇[1] Zhou Yongzhi;Yang Guangchao;Li Zhongyu;Meng Zhanzhi;Wang Mingyuan;Li Linqiang;Song Xuan;Ma Yong(Department of Hepatic Mini-invasive Surgery,First Affiliated Hospital,Harbin Medical University,Key Laboratory of Hepatosplenic Surgery,Ministry of Education,Heilongjiang Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院肝脏微创外科,省部共建教育部肝脾外科重点实验室,黑龙江哈尔滨150001

出　　处：《腹部外科》2023年第1期17-24,共8页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81100305,81470876);黑龙江省自然科学基金(LC2018037);博士后研究人员落户黑龙江科研启动资助金(LBH-Q17097)。

摘　　要：目的比较机器人肝切除术与腹腔镜肝切除术治疗肝癌、肝血管瘤的短期疗效及安全性。方法回顾性分析哈尔滨医科大学附属第一医院2019年12月至2022年9月接受机器人或腹腔镜肝切除术的肝癌及肝血管瘤病人资料。共纳入肝癌病人145例,机器人组32例,腹腔镜组113例;纳入肝血管瘤病人229例,机器人组55例,腹腔镜组174例。观察分析各组病人手术时间、术中出血量、术中输血量、中转开腹情况、术后肝功能、术后凝血指标、术后并发症、住院时间以及住院费用等临床资料[偏态分布计量资料采用M(P25,P75)表示]。结果在肝癌病人治疗过程中,机器人组较腹腔镜组明显缩短手术时间[195.0(150.0,268.3)min比270.0(195.0,350.0)min],术中出血量更少[75.0(50.0,187.5)mL比100.0(50.0,300.0)mL],中转开腹率低[0例比17例(15.0%)],但住院费用相对较高[(100547.8±17176.0)元比(84771.4±19856.7)元],差异均有统计学意义(均P<0.05)。在肝血管瘤病人治疗过程中机器人组手术时间更短[155.0(130.0,195.0)min比215.0(165.0,285.0)min],术中出血量更少[50.0(20.0,100.0)mL比100.0(50.0,200.0)mL],住院费用相对较高[80674.0(75393.0,86222.0)元比70648.9(61129.9,80032.9)元],差异均有统计学意义(均P<0.05)。结论在肝癌及肝血管瘤病人的治疗过程中,机器人肝切除术较腹腔镜肝切除术具有更多优势,诸如手术时间短、术中出血量少等,而且机器人手术优势在肝癌手术治疗中体现更为明显。Objective To compare the short-term efficacy and safety of robotic hepatectomy(RH)and laparoscopic hepatectomy(LH)for hepatocellular carcinoma(HCC)and hepatic hemangioma(HH).Methods The relevant clinical data were retrospectively reviewed for HCC/HH patients undergoing RH/LH from December 2019 to September 2022.A total of 145 HCC patients were assigned into two groups of robotic(n=32)and laparoscopic(n=113).And 229 HH patients were divided into two groups of robotic(n=55)and laparoscopic(n=174).Operative duration,intraoperative blood loss,intraoperative blood transfusion,conversion into open surgery,postoperative liver function tests,postoperative coagulation parameters,postoperative hemorrhage,postoperative bile leakage,postoperative ascites,postoperative mortality,length of hospital stay and hospitalization expense were examined for comparing the short-term efficacy and safety of RH/LH for HCC/HH.Results As compared with laparoscopic group,robotic group had significantly shorter median operative duration[195.0(150.0,268.3)vs.270.0(195.0,350.0)min],lower median blood loss[75.0(50.0,187.5)vs.100.0(50.0,300.0)mL]and lower conversion rate into open surgery[0 vs.17(15.0%)].However,hospitalization expense was relatively higher[(100547.8±17176.0)vs.(84771.4±19856.7)yuan].The differences were statistically significant(P<0.05).For HH patients,median operative duration of robotic group was shorter[155.0(130.0,195.0)vs.215.0(165.0,285.0)min]and median blood loss smaller[50.0(20.0,100.0)vs.100.0(50.0,200.0)mL].Median hospitalization expense was relatively higher[80674.0(75393.0,86222.0)vs.70648.9(61129.9,80032.9)yuan]and the differences were statistically significant(P<0.05).Conclusion For HCC/HH patients,RH offers more advantages than LH,such as shorter operative duration and minimal blood loss.And the advantages of robotic surgery are more pronounced for HCC.

关 键 词：机器人肝切除 腹腔镜肝切除 肝癌 肝血管瘤 

分 类 号：R657.3[医药卫生—外科学]