机器人与3D腹腔镜远端胃癌根治术的近远期疗效对比研究  

Comparison of the short-and long-term outcomes of robotic distal gastrectomy and 3D laparoscopic distal gastrectomy for gastric cancer

作　　者：刘贵宾 崔昊 曹博 梁文全 陈润开 宋立强 黄俊 袁震 卫勃 LIU Gui-bin;CUI Hao;CAO Bo(Department of General Surgery,Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University)

机构地区：[1]中国人民解放军总医院第一医学中心普通外科医学部,北京100853 [2]南开大学医学院

出　　处：《腹腔镜外科杂志》2023年第1期22-29,共8页Journal of Laparoscopic Surgery

基　　金：国家重点研发计划课题(2019YFB1311505);国家自然科学基金(82073192);国家自然科学基金(82273231);北京市科技计划项目(Z221100007422125)。

摘　　要：目的:比较机器人与3D腹腔镜远端胃癌根治术的近远期预后及影响远期预后的相关因素,以期指导合理选择手术方式。方法:采用回顾性研究方法收集2016年1月至2018年3月256例行3D腹腔镜与机器人远端胃癌根治术患者的临床与病理信息,其中3D腹腔镜组139例,机器人组117例;两组患者基线资料、肿瘤病理学特征差异无统计学意义(P>0.05)。结果:机器人组与3D腹腔镜组手术时间差异无统计学意义[(241.69±47.14)min vs.(237.82±40.26)min,P=0.485],3D腹腔镜组淋巴结清扫数量[(29.33±13.02)vs.(24.82±9.50),P=0.002]、术中出血量>200 mL的比例(13.7%vs.4.3%,P=0.010)高于机器人组。近期疗效方面,3D腹腔镜组首次排气时间长于机器人组[(4.25±1.20)d vs.(3.26±1.44)d,P<0.001],手术费用少于机器人组[3.07(2.36-3.82)万元vs.5.31(4.98-5.77)万元,P<0.001],两组术后住院时间差异无统计学意义(P>0.05)。3D腹腔镜组与机器人组总体并发症发生率(12.9%vs.17.1%)与严重并发症发生率(0.7%vs.4.3%)差异均无统计学意义(P>0.05)。远期预后方面,3D腹腔镜组与机器人组3年总体生存率差异无统计学意义(80.6%vs.83.8%,P>0.05)。亚组分析显示,在3D腹腔镜组与机器人组中,术后病理为Ⅰ期、Ⅱ期、Ⅲ期的患者生存率差异无统计学意义(92.6%vs.97.8%,86.1%vs.94.3%,63.3%vs.55.6%,P>0.05)。单因素COX回归分析显示,性别、年龄、肿瘤大小、TNM分期与胃癌患者远期预后相关(P<0.05);多因素分析显示,女性、年龄≥65岁、较晚TNM分期是影响胃癌患者总体生存的独立危险因素(P<0.05),手术方式并不是影响胃癌患者生存的独立危险因素(P=0.760)。结论:机器人远端胃癌根治术的近远期疗效与3D腹腔镜手术相当,对于女性、高龄、TNM分期较晚的胃癌患者应重视术后综合治疗,以提高远期预后。Objective:To compare the short-and long-term outcomes between robotic distal gastrectomy(RDG)versus 3D laparoscopic distal gastrectomy(3D-LDG)and figure out the related factors affecting long-term prognosis so as to provide reference for selecting appropriate surgical approaches.Methods:A retrospective study method was adopted.Clinical and pathological characteristics of 256 patients who underwent 3D-LDG versus RDG between Jan.2016 and Mar.2018 were collected,including 139 patients in the 3D-LDG group and 117 patients in the RDG group.There was no statistical difference in the baseline and pathological characteristics between the two groups.Results:Compared with the RDG group,the 3D-LDG group had comparable operative time[(241.69±47.14)min vs.(237.82±40.26)min,P=0.485],more retrieved lymph nodes[(29.33±13.02)vs.(24.82±9.50),P=0.002]and higher proportion of blood loss over 200 mL(13.7%vs.4.3%,P=0.010).For postoperative recent indexes,the 3D-LDG group had longer first flatus time[(4.25±1.20)d vs.(3.26±1.44)d,P<0.001]and fewer surgery costs[30.7(28.6-38.2)thousand RMB vs.53.1(49.8-57.7)thousand RMB,P<0.001),but the postoperative hospital stay between the two groups were comparable(P>0.05).There was no significant difference in overall complication rate(12.9%vs.17.1%)and severe complication rate(0.7%vs.4.3%)between 3D-LDG and RDG groups(P>0.05).As for the aspect of long-term prognosis,there was no significant difference in the 3-year overall survival rate between the 3D-LDG and RDG groups(80.6%vs.83.8%,P>0.05).The subgroup analysis showed that the survival rates between the 3D-LDG and RDG groups were(92.6%vs.97.8%),(86.1%vs.94.3%)and(63.3%vs.55.6%)for patients with pTNM stageⅠ,ⅡandⅢ,respectively,with no statistically significant differences(P>0.05).Univariate COX regression analysis showed that gender,age,tumor size,and TNM stage were associated with the long-term prognosis for patients who accepted 3D-LDG and RDG(P<0.05).Multivariate analysis showed that female,age≥65 years,and poor pTNM stage were the

关 键 词：胃肿瘤 机器人手术 腹腔镜检查 成像 三维 预后 疗效比较研究 

分 类 号：R735.2[医药卫生—肿瘤]