机器人与腹腔镜胃切除术治疗局部进展期胃癌的患者报告结局的单中心随机对照研究  

Patient-reported outcomes of locally advanced gastric cancer undergoing robotic versus laparoscopic gastrectomy:a randomized controlled study

作　　者：王庆睿 曹守根[1] 孟成[1] 刘晓东[1] 李泽群 田玉龙 徐剑飞[1] 孙钰淇 刘淦 张兴起 贾琢玉 钟浩 杨浩 牛兆建[1] 周岩冰[1] Wang Qingrui;Cao Shougen;Meng Cheng;Liu Xiaodong;Li Zequn;Tian Yulong;Xu Jianfei;Sun Yuqi;Liu Gan;Zhang Xingqi;Jia Zhuoyu;Zhong Hao;Yang Hao;Niu Zhaojian;Zhou Yanbing(Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院胃肠外科,青岛266003

出　　处：《中华外科杂志》2024年第1期57-64,共8页Chinese Journal of Surgery

基　　金：山东省自然科学基金(ZR2021MH001)。

摘　　要：目的比较机器人与腹腔镜辅助根治性胃切除术治疗局部进展期胃癌的患者报告结局及近期临床结局。方法本研究为单中心前瞻性随机对照研究,于2020年10月至2022年8月在青岛大学附属医院胃肠外科进行。选择拟接受根治性胃切除术治疗的局部进展期胃癌患者入组,按1∶1随机分为两组,分别接受机器人手术和腹腔镜手术。比较两组的患者报告结局和近期临床结局(包括术后并发症发生率、手术质量和术后近期恢复情况)。定量资料的比较采用独立样本t检验、Mann-Whitney U检验、重复测量方差分析或广义估计方程,分类资料的比较采用χ^(2)检验和Fisher确切概率法。结果共有237例患者纳入改良意向治疗分析(机器人组120例,腹腔镜组117例)。男性180例,女性59例;年龄(63.0±10.2)岁(范围:30~85岁)。机器人组和腹腔镜组术后并发症发生率相似[16.7%(20/120)比15.4%(18/117),χ^(2)=0.072,P=0.788]。机器人组在一般健康状况、情绪和社会领域的患者报告结局评分更高,其时间效应、干预效应、交互效应的差异均有统计学意义(一般健康状况:χ^(2)值分别为275.68、3.91、6.38,P值分别为<0.01、0.048、0.041;情绪:χ^(2)值分别为77.79、6.04、6.15,P值分别为<0.01、0.014、0.046;社会:χ^(2)值分别为148.00、7.57、5.98,P值分别为<0.01、0.006、0.048)。机器人组患者面临更重的经济负担(时间效应、干预效应、交互效应χ^(2)值分别为156.24、4.08、36.56,P值分别为<0.01、0.043、<0.01)。结论与腹腔镜胃切除术相比,机器人手术可以更有效地缓解患者术后的负面情绪,并且有利于患者社会功能的快速恢复。Objective To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer.Methods This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University from October 2020 to August 2022.Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1,and received robotic surgery and laparoscopic surgery,respectively.Patient-reported outcomes and short-term clinical outcomes(including postoperative complications,surgical quality and postoperative short-term recovery)were compared between the two groups by independent sample t test,Mann-Whitney U test,repeated ANOVA,generalized estimating equation,χ^(2) test and Fisher's exact test.Results A total of 237 patients were enrolled for modified intention-to-treat analysis(120 patients in the robotic group,117 patients in the laparoscopic group).There were 180 males and 59 females,aged(63.0±10.2)years(range:30 to 85 years).The incidence of postoperative complications was similar between the robotic group and laparoscopic group(16.7%(20/120)vs.15.4%(18/117),χ^(2)=0.072,P=0.788).The robotic group had higher patient-reported outcomes scores in general health status,emotional,and social domains compared to the laparoscopic group,differences in time effect,intervention effect,and interaction effect were statistically significant(general health status:χ^(2) value were 275.68,3.91,6.38,P value were<0.01,0.048,0.041;emotional:χ^(2) value were 77.79,6.04,6.15,P value were<0.01,0.014,0.046;social:χ^(2) value were 148.00,7.57,5.98,P value were<0.01,0.006,0.048).However,the financial burden of the robotic group was higher,the differences in time effect,intervention effect and interaction effect were statistically significant(χ^(2) value were 156.24,4.08,36.56,P value were<0.01,0.043,

关 键 词：胃肿瘤 胃切除术 机器人 腹腔镜检查 患者报告结局 临床结局 

分 类 号：R735.2[医药卫生—肿瘤]