机器人与腹腔镜辅助直肠癌根治术的手术疗效与预后对比  

Comparison of surgical efficacy and clinical prognosis between robotic-and laparoscopic-assisted radical rectal cancer surgery

作　　者：吴登峰 刘源 田志强 沈伟 WU Dengfeng;LIU Yuan;TIAN Zhiqiang;SHEN Wei(Department of General Surgery,The Affiliated Wuxi People s Hospital of Nanjing Medical University/Wuxi Medical Center of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学无锡医学中心/南京医科大学附属无锡人民医院普外科,江苏无锡214023

出　　处：《中国肿瘤外科杂志》2024年第1期47-53,共7页Chinese Journal of Surgical Oncology

基　　金：无锡市卫健委面上项目(M202168);无锡市卫健委中青年拔尖人才资助计划(HB2020007)。

摘　　要：目的对比达芬奇机器人手术辅助、腹腔镜辅助直肠癌根治术的手术疗效与近期预后,并探究两种手术方式在特定人群中的适应证。方法采用回顾性队列研究方法,收集2020年1月至2022年12月期间,南京医科大学附属无锡人民医院普外科收治的直肠癌手术患者的基线资料及临床相关资料,进行1∶1倾向性评分匹配。匹配成功的机器人手术70例,腹腔镜手术70例,对比分析两组患者的手术指标及预后疗效指标,并进行亚组分析。结果与腹腔镜手术组相比,机器人手术组患者术中出血量少、腹部切口小、淋巴结清扫更广泛,术后恢复排气时间,排便时间短,术后吻合口瘘、肺炎、伤口感染、总并发症发生率低(P<0.05)。亚组分析结果显示,高BMI、高龄及基础病史亚组中,机器人手术术中出血量更低,手术时间更短,术后首次排气时间、排便时间更早,术后并发症更少。结论机器人辅助直肠癌根治术的手术根治性、安全性较好,患者术后近期预后效果佳,而且更适合体质指数高、高龄及有基础疾病的患者。而且随着操作医生的熟练程度增加,机器人手术时间缩短、术中出血量减少、术后并发症更少。但目前采用何种手术方式,需要结合实际,兼顾考虑多方面因素,从而实现对直肠癌患者的个性化治疗。Objective To compare the surgical outcomes and recent prognosis of da Vinci robotic-assisted and laparoscopic-assisted radical rectal cancer surgery,and to explore the indications of the both surgical approaches in specific populations.Methods A retrospective cohort study was used to collect baseline data and clinically relevant information from rectal cancer surgery patients admitted to the Department of General Surgery,The Affiliated Wuxi People s Hospital of Nanjing Medical University from January 2020 to December 2022,and 1∶1 propensity score matching was performed.Seventy cases of successful robotic surgery and seventy cases of laparoscopic surgery were matched.Surgical indexes and prognostic efficacy indexes of the two groups were compared and analyzed,and subgroup analysis was performed.Results Compared with the laparoscopic surgery group,patients in the robotic surgery group had less intraoperative bleeding,smaller abdominal incisions,more extensive lymph node dissection,shorter postoperative recovery time for exhaustion,shorter defecation time,and lower incidence of postoperative anastomotic fistula,pneumonia,wound infection,and overall complications(P<0.05).The results of subgroup analysis showed that in the subgroup with high BMI,older age,and underlying medical history,robotic surgery had lower intraoperative bleeding,shorter operation time,earlier time to first postoperative exhaust and defecation,and fewer postoperative complications.Conclusions Robotic-assisted radical rectal cancer surgery has better surgical radicality and safety,better prognosis for patients in the immediate postoperative period,and is more suitable for patients with high BMI,older age,and underlying disease.Moreover,with increased proficiency of the operating surgeon,robotic surgery time is shortened,intraoperative bleeding is reduced,and postoperative complications are less frequent.However,the current surgical approach requires a combination of practical and multifaceted considerations to achieve individualized treatment fo

关 键 词：直肠癌 机器人手术 腹腔镜手术 临床疗效 对比研究 

分 类 号：R735.37[医药卫生—肿瘤]