"膜"解剖引导下的DaVinci机器人直肠癌手术与腹腔镜全直肠系膜切除术临床疗效的对照研究  

A comparative study on the clinical efficacy of DaVincin robot rectal cancer surgery guided by"membrane"anatomy and laparoscopic total mesorectal resection

作　　者：马宁[1] 刘威[1] 陈志奇[1] 陈旭[1] 范宏伟 殷响[1] Ning Ma;Wei Liu;Zhiqi Chen;Xu Chen;Hongwei Fan;Xiang Yin(Department of General Surgery,Daqing Oilfifield General Hospital,Daqing,163000,China)

机构地区：[1]大庆油田总医院普通外科,163000

出　　处：《中华结直肠疾病电子杂志》2024年第1期45-53,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：黑龙江省卫生健康委科研课题(No.2020-013);大庆市指导性科技计划项目(No.zdy-2021-81)。

摘　　要：目的通过比较分析"膜"解剖引导下的DaVinci机器人直肠手术与腹腔镜全直肠系膜切除术(TME)的临床疗效,探讨"膜"解剖引导下的DaVinci机器人直肠手术应用开展的可能性及其价值。方法应用回顾性队列研究方法,依据纳入及排除标准收集大庆油田总医院普通外科2022年2月~2023年9月期间收治的60例直肠癌患者临床资料。按照手术方式分为两组,观察组为"膜"解剖引导下DaVinci机器人直肠癌手术组29例,对照组为腹腔镜下TME组31例。记录观察指标包括手术时间、术中出血量、切除标本质量、系膜完整性、淋巴结数目、阳性淋巴结数目、术后出现并发症情况及术后14天的生活自理能力、心理情况、术后三个月的排尿及性功能恢复等。结果两组所有患者均顺利完成手术,随访期内无死亡患者,两组在手术时间、术中出血量、保护性造口比例,肿瘤远切缘距离、TNM分期、淋巴结清扫数目及阳性数目,术后首次下床活动时间、术后首次肛门排气时间、术后恢复饮食时间、术后并发症总比例比较上差异均无统计学意义(P>0.05)。两组在切除标本质量评定达标总体上的差异无统计学意义(χ^(2)=0.809,P=0.384),但从标本高质量完成上比较观察组(93.1%)明显优于对照组(71.0%),在住院时间、住院费用两组比较差异具有统计学意义(t=-5.133,12.700;均P<0.05),观察组住院时间(9.8±2.8)d短于对照组(11.8±4.3)d,但住院费用稍高于对照组(8.9±2.8 vs.7.2±1.1)万元。术后14天日常活动自理能力及心理恢复评分两组存在差异,观察组均优于对照组(t=26.608,-12.207;均P<0.05)。术后并发症发生率观察组(13.8%)低于对照组(22.5%)。在距肛缘>5 cm患者中两组吻合口出血差异无统计学意义(χ^(2)=0.850,P>0.05);但在距肛缘≤5 cm患者中,观察组低于对照组,差异具有统计学意义(χ^(2)=9.253,P<0.05)。术后3个月排尿及生殖功能的比较,观察组优于�Objective By comparing and analyzing the clinical effects of DaVinci robot rectal surgery guided by"membrane"anatomy and laparoscopic total mesorectal resection(TME),the possibility and value of DaVinci robot assisted rectal surgery under the guidance of"membrane"anatomy were discussed.Methods Retrospective cohort study was used.The clinical data of 60 patients with rectal cancer treated in the Department of General surgery of Daqing Oilfield General Hospital from February 2022 to September 2023 were collected according to the inclusion and exclusion criteria.According to the mode of operation,the patients were divided into two groups:observation group(n=29)and control group(n=31).The observation group was assisted by DaVinci robot under the guidance of membrane anatomy,and the control group was treated with laparoscopic TME.The observation indexes were recorded,such as operation time,intraoperative blood loss,quality of resected specimens,mesangial integrity,number of lymph nodes,number of positive lymph nodes,postoperative complications and self-care ability,psychological condition,voiding and sexual function recovery three months after operation.Results All patients in the two groups completed the operation successfully,and there was no death during the follow-up period,there was no significant difference between the two groups in terms of operation time,intraoperative blood loss,proportion of protective stoma,distance of distant cutting edge of tumor,TNM stage,number of lymph node dissection and positive number,first time of getting out of bed after operation,time of first anal exsufflation after operation,time of recovery of postoperative diet and total proportion of postoperative complications.There was no statistical significance(P>0.05).There was no significant difference in the quality evaluation of resected specimens between the two groups(χ^(2)=0.809,P=0.384),but in terms of high quality,the observation group(93.1%)was significantly better than the control group(71.0%).There were significant differenc

关 键 词：直肠肿瘤 膜解剖 DaVinci机器人 腹腔镜手术 功能保护 

分 类 号：R735.37[医药卫生—肿瘤]