机器人辅助与腹腔镜辅助胃切除术学习曲线的比较  

Comparison of the learning curve of robot-assisted and laparoscopic-assisted gastrectomy

作　　者：谢京茂 雷阳 张皓 刘毅辉 易波[1] XIE Jingmao;LEI Yang;ZHANG Hao;LIU Yihui;YI Bo(Second Department of Gastrointestinal,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院胃肠二科,长沙410013

出　　处：《中南大学学报（医学版）》2023年第5期716-724,共9页Journal of Central South University ：Medical Science

基　　金：湖南省重点研发计划项目(2021SK2001)。

摘　　要：目的:随着微创外科技术的发展,达芬奇机器人技术的应用越来越广泛。本研究通过分析机器人辅助胃切除术(robotic-assisted gastrectomy,RAG)与腹腔镜辅助胃切除术(laparoscopic-assisted gastrectomy,LAG)2种不同外科技术初期阶段学习曲线的比较,探讨先进手术机器人技术对外科手术学习曲线的可能影响。方法:选取在2017年9月至2020年12月一名主刀医师从初始阶段开始实施RAG或LAG手术的远端胃癌根治术的108例患者,分为行达芬奇Si机器人系统RAG的RAG组(n=27)和行LAG的LAG组(n=81),胃癌区域淋巴结分组参照日本胃癌治疗指南实施,分析其围手术期结果、术后并发症、术后肿瘤学结果和外科手术学习曲线等相关情况。结果:2组患者在一般资料、肿瘤大小、组织学分级和临床分期上的差异均无统计学意义(均P>0.05);RAG组术后严重并发症的发生率低于LAG组(P=0.003);RAG组术中的失血量低于LAG组的失血量(P=0.046);RAG组清扫淋巴结数量更多(P=0.003),其中在第9组(P=0.038)和11p组(P=0.015)淋巴结清扫中表现出明显优势;RAG组手术时间明显比LAG组长(P=0.015);学习曲线分析发现,RAG组的累积和分析(cumulative sum analysis,CUSUM)值从第10例开始下降,而LAG组的CUSUM值从第28例开始下降,RAG的学习曲线比LAG的学习曲线具有更少的截止案例。手术机器人的独特设计可能有助于提高手术效率和缩短外科手术学习曲线。结论:先进机器人技术有助于经验丰富的外科医生快速学习掌握RAG技能,超越机器人学习曲线达到熟练阶段需要的最少手术例数为10例,并在第9组和11p组淋巴结清扫和减轻手术创伤方面优于LAG。RAG手术比LAG手术能清扫出更多的淋巴结,有更好的围手术期疗效。Objective:Da Vinci robot technology is widely used in clinic,with minimally invasive surgery development.This study aims to explore the possible influence of advanced surgical robotics on the surgery learning curve by comparing the initial clinical learning curves of 2 different surgical techniques:robotic-assisted gastrectomy(RAG)and laparoscopic-assisted gastrectomy(LAG).Methods:From September 2017 to December 2020,a chief surgeon completed a total of 108 cases of radical gastric cancer from the initial stage,including 27 cases of RAG of the Da Vinci Si robotic system(RAG group)and 81 cases of LAG(LAG group).The lymph node of gastric cancer implemented by the Japanese treatment guidelines of gastric cancer.The surgical results,postoperative complications,oncology results and learning curve were analyzed.Results:There was no significant difference in general data,tumor size,pathological grade and clinical stage between the 2 groups(P>0.05).The incidence of serious complications in the RAG group was lower than the LAG group(P=0.003).The intraoperative blood loss in the RAG group was lower than that in the LAG group(P=0.046).The number of lymph nodes cleaned in the RAG group was more(P=0.003),among which there was obvious advantage in lymph node cleaning in the No.9 group(P=0.038)and 11p group(P=0.015).The operation time of the RAG group was significantly longer than the LAG group(P=0.015).The analysis of learning curve found that the cumulative sum analysis(CUSUM)value of the RAG group decreased from the 10th case,while the CUSUM of the LAG group decreased from the 28th case.The learning curve of the RAG group had fewer closing cases than that of the LAG group.The unique design of the surgical robot might help to improve the surgical efficiency and shorten the surgical learning curve.Conclusion:Advanced robotics helps experienced surgeons quickly learn to master RAG skills.With the help of robotics,RAG are superior to LAG in No.9 and 11p lymph node dissection and surgical trauma reduction.RAG can clear more lymph

关 键 词：达芬奇机器人系统 机器人辅助下胃切除术 D2淋巴结清扫 胃癌 

分 类 号：R735.2[医药卫生—肿瘤] TP242[医药卫生—临床医学]