机器人手术系统在低位直肠癌根治术联合侧方淋巴结清扫术中的应用  

Application of robotic surgery system in radical resection of low rectal cancer combined with lateral lymph node dissection

作　　者：谷晓明[1] 袁维堂[1] GU Xiaoming;YUAN Weitang(Department of Colorectal and Anal Surgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科,郑州450052

出　　处：《郑州大学学报(医学版)》2023年第6期806-811,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金联合基金项目(U2004112)。

摘　　要：目的:评估机器人手术系统在低位直肠癌根治术(TME)联合侧方淋巴结清扫术(LLND)中的可行性及安全性。方法:选取2016年3月至2020年6月郑州大学第一附属医院收治的低位直肠癌合并侧方淋巴结肿大的患者187例,其中46例接受机器人手术系统辅助下TME+LLND(机器人组),141例接受腹腔镜下TME+LLND(腹腔镜组)。随访至2022年3月。比较2组的疗效和安全性指标。结果:2组患者均顺利完成手术。与腹腔镜组相比,机器人组保肛率高(71.7%vs 54.6%),手术时间短[(242.61±44.99) min vs(300.64±58.78) min],LLND时间短[(89.78±21.86) min vs(119.01±24.36) min],出血量少[(134.13±59.58) mL vs(371.21±181.11) mL],排气时间短[(2.96±0.82) d vs(3.75±1.10) d],术后住院时间短[(10.63±1.64) d vs(13.63±1.73) d],淋巴瘘发生率低(21.7%vs 38.3%)(P均<0.05);机器人组术后性功能及排尿功能评分均优于腹腔镜组(P<0.05)。机器人组侧方淋巴结清扫数多于腹腔镜组[(7.87±2.28)vs(5.69±2.39)](P<0.05)。2组患者总生存期、无病生存期差异均无统计学意义(P>0.05)。结论:机器人手术系统辅助下TME+LLND治疗低位直肠癌合并侧方淋巴结肿大安全、可行。Aim:To evaluate the feasibility and safety of robotic surgery system in radical resection of low rectal cancer combined with lateral lymph node dissection(LLND).Methods:Totally 187 patients with low rectal cancer combined with lateral lymph node enlargement were selected from the First Affiliated Hospital of Zhengzhou University from March 2016 to June 2020,among whom,46 underwent radical rectal cancer resection(adopting total mesorectal excision,TME) combined with LLND with the assistance of robotic surgery system(robot group),and 141 underwent laparoscopic TME combined with LLND(laparoscopic group).All the patients were followed up till March 2022.The efficacy and safety indexes of the 2 groups were compared.Results:All the operations were successfully completed in both groups.Compared with the laparoscopic group,the robot group had a higher rate of anal preservation(71.7% vs 54.6%),shorter operation time[(242.61±44.99) min vs(300.64±58.78) min],shorter LLND time[(89.78±21.86) min vs(119.01±24.36) min],and smaller amount of bleeding[(134.13±59.58) mL vs(371.21±181.11) mL].The robot group had shorter exhaust time[(2.96±0.82) days vs(3.75±1.10) days] and postoperative hospital stay[(10.63±1.64) days vs(13.63±1.73) days],and the incidence of lymphatic fistula was lower(21.7% vs 38.3%)(P<0.05).The scores of postoperative sexual function and urinary function of the robot group were superior to those in the laparoscopic group(P<0.05).The number of cleaning lateral lymph nodes in the robot group was larger than that in the laparoscopic group[(7.87±2.28) vs(5.69±2.39)](P<0.05).There was no significant difference in overall survival or disease-free survival between the 2 groups(P>0.05).Conclusion:TME combined with LLND with the assistance of robotic surgical system is safe and feasible for the treatment of low rectal cancer complicated with lateral lymph node enlargement.

关 键 词：机器人手术系统 腹腔镜手术 低位直肠癌 侧方淋巴结清扫 

分 类 号：R735.3[医药卫生—肿瘤]