第4代达芬奇机器人手术系统辅助保留幽门及迷走神经胃部分切除术治疗早期胃癌的临床疗效  

Clinical efficacy of da Vinci Xi robotic surgical system assisted pylorus and vagus preser-ving partial gastrectomy for early gastric cancer

作　　者：范义川 张驰[1] 魏茂华[1] 钟华[2] 段海涛 孙伟峰 曹亮[1] 张健[1] 梁品[1] 胡祥[1] Fan Yichuan;Zhang Chi;Wei Maohua;Zhong Hua;Duan Haitao;Sun Weifeng;Cao Liang;Zhang Jian;Liang Pin;Hu Xiang(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Information Construction and Medical Record Management,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院胃肠外科,大连116011 [2]大连医科大学附属第一医院信息建设与病案管理部,大连116011

出　　处：《中华消化外科杂志》2023年第8期1014-1020,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81572883)。

摘　　要：目的探讨第4代达芬奇机器人手术系统辅助保留幽门及迷走神经胃部分切除术(RaPPG)治疗早期胃癌的临床疗效。方法采用回顾性队列研究方法。收集2020年12月至2022年11月大连医科大学附属第一医院收治的40例早期胃癌患者的临床病理资料;男26例,女14例;年龄为(64±8)岁。40例患者中,19例行第4代达芬奇RaPPG,设为机器人辅助组;21例行腹腔镜辅助保留幽门及迷走神经胃部分切除术(PPG),设为腹腔镜对照组。观察指标:(1)手术情况。(2)术后并发症情况。(3)随访情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q1,Q3)或M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用秩和检验。结果(1)手术情况。两组患者均顺利完成手术,无中转开腹。机器人辅助组患者手术时间、术中出血量、术后首次肛门排气时间、术后首次进食流质食物时间、术后引流管拔除时间、术后住院时间、肿瘤长径、远端切缘距肿瘤距离分别为(298±52)min、10(10,10)mL、3.0(3.0,3.0)d、3.0(3.0,4.0)d、6.0(6.0,8.0)d、7.0(6.0,8.0)d、(2.3±0.7)cm、3.0(2.0,3.0)cm;腹腔镜对照组患者上述指标分别为(236±37)min、25(15,50)mL、5.0(4.0,5.0)d、6.0(5.5,7.0)d、8.0(8.0,9.5)d、8.0(7.5,9.5)d、(2.9±1.1)cm、2.0(1.5,2.0)cm,两组患者上述指标比较,差异均有统计学意义(t=4.41,Z=-3.38、-4.75、-4.38、-2.98、-2.58,t=-2.10,Z=-3.03,P<0.05)。(2)术后并发症情况。机器人辅助组患者术后总并发症、胃排空延迟、反酸、肺不张、切口感染、高淀粉酶血症、尿潴留分别为6、1、1、0、1、3、0例,腹腔镜对照组患者上述指标分别为20、4、3、2、1、9、1例,两组术后总并发症比较,差异有统计学意义(χ^(2)=17.77,P<0.05)。(3)随访情况。40例患者中,34例获得随访。机器人辅助组Objective To investigate the clinical efficacy of da Vinci Xi robotic surgical system assisted pylorus and vagus preserving partial gastrectomy(RaPPG)for early gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2020 to November 2022 were collected.There were 26 males and 14 females,aged(64±8)years.Of the 40 patients,19 patients undergoing da Vinci Xi RaPPG were divided into the robotic assisted group,and 21 patients undergoing laparoscopic assisted pylorus and vagus preserving partial gastrectomy(PPG)were divided into the laparoscopic control group.Observation indicators:(1)surgical situations;(2)postoperative complications;(3)follow-up.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent t test.Measurement data with skewed distribution were represented as M(Q1,Q3)or M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data was conducted using the rank sum test.Results(1)Surgical situations.All patients in the two groups underwent surgery successfully,without conversion to laparotomy.The operation time,volume of intraoperative blood loss,time to postoperative first flatus,time to postoperative first liquid food intake,time to post-operative drainage tube removal,duration of postoperative hospital stay,tumor diameter,distance from distal resection margin to tumor were(298±52)minutes,10(10,10)mL,3.0(3.0,3.0)days,3.0(3.0,4.0)days,6.0(6.0,8.0)days,7.0(6.0,8.0)days,(2.3±0.7)cm,3.0(2.0,3.0)cm in patients of the robotic assisted group,versus(236±37)minutes,25(15,50)mL,5.0(4.0,5.0)days,6.0(5.5,7.0)days,8.0(8.0,9.5)days,8.0(7.5,9.5)days,(2.9±1.1)cm,2.0(1.5,2.0)cm i

关 键 词：胃肿瘤 达芬奇机器人手术系统 迷走神经 幽门 腹腔镜胃切除术 疗效 并发症 

分 类 号：R735.2[医药卫生—肿瘤]