第4代达芬奇机器人手术系统与腹腔镜辅助胃癌根治术的近期疗效对比分析  

Short-term outcomes of the Da Vinci Xi(fourth generation)robotic surgical system and laparoscopic-assisted gastrectomy for gastric cancer:a retrospective cohort study

作　　者：范义川 张驰[1] 梁品[1] 胡祥[1] Fan Yichuan;Zhang Chi;Liang Pin;Hu Xiang(Department of Gastrointestinal Surgery,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

出　　处：《中华胃肠外科杂志》2024年第8期808-815,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目(81572883)。

摘　　要：目的:比较分析第4代达芬奇机器人手术系统与腹腔镜辅助胃癌根治术的近期疗效。方法:采用回顾性队列研究方法,收集大连医科大学附属第一医院2020年12月至2023年5月期间收治的190例胃癌患者临床病理资料。其中男136例,女54例;中位年龄为65(30~85)岁。190例患者中,90例行机器人手术系统辅助胃癌根治性切除+消化道重建术(机器人手术组),100例行腹腔镜辅助胃癌根治性切除+消化道重建术(腹腔镜手术组)。主要观察指标为手术和术后恢复情况,以及术后并发症情况。结果:两组患者均顺利完成手术,无中转开腹。机器人手术组和腹腔镜手术组患者中位手术时间分别为315(270,360)min和240(202,280)min,中位术中出血量分别为20(10,30)ml和30(10,50)ml,中位切口长度分别为12.0(10.8,13.0)cm和10.0(8.0,10.8)cm,术后首次肛门排气中位时间分别为4(3,5)d和4(4,5)d,术后首次进食流食中位时间分别为6(4,7)d和8(6,9)d,术后拔胃管中位时间分别为4(3,7)d和6(5,8)d,拔除引流管中位时间分别为8(7,10)d和10(9,12)d,术后中位住院时间分别为8(7,11)d和12(10,14)d,手术费用分别为(7.6±1.2)万元和(4.0±0.6)万元,差异均有统计学意义(均P<0.05)。机器人手术组总并发症发生率低于腹腔镜手术组[28.9%(26/90)和44.0%(44/100)],差异有统计学意义(χ2=0.31,P=0.031);进一步亚组分析显示,男性(OR=0.41,95%CI:0.20~0.83,P=0.015)、体质指数<25 kg/m 2(OR=0.41,95%CI:0.19~0.87,P=0.023)、美国麻醉医师协会分级2~3级(OR=0.14,95%CI:0.04~0.42,P=0.001)、术前合并基础疾病(OR=0.29,95%CI:0.11~0.76,P=0.013)以及TNM分期Ⅰ~Ⅱ期(OR=0.36,95%CI:0.13~0.91,P=0.035)亚组群体中,机器人手术的总并发症率更低,差异均有统计学意义(均P<0.05)。结论:第4代达芬奇机器人手术系统辅助治疗胃癌安全可行,术后恢复较快,并发症较少。Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi(fourth generation)robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study,clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May.The cohort comprised 136 men and 54 women aged 65(30–85)years.Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group.The remaining 100 patients had undergone laparoscopic-assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group.Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups.The median duration of surgery was 315(270,360)minutes and 240(202,280)minutes,median intraoperative blood loss 20(10,30)mL and 30(10,50)mL,median incision length 12.0(10.8,13.0)cm and 10.0(8.0,10.8)cm,median time to first postoperative passage of flatus 4(3,5)days and 4(4,5)days,median time to first postoperative fluid intake 6(4,7)days and 8(6,9)days,time to gastric tube removal 4(3,7)days and 6(5,8)days,median time to drainage tube removal 8(7,10)days and 10(9,12)days,median duration of postoperative hospitalization 8(7,11)days and 12(10,14)days,and cost of surgery(7.6±1.2)×10^(4) yuan and(4.0±0.6)×10^(4) yuan in the robot-assisted and laparoscopic control groups,respectively.All the differences in the above indicators between the two groups of patients were statistically significant(all P<0.05).There were also significantly fewer complications in the robot-assisted than the laparoscopic control group(28.9%[26/90]vs.44.0%[44/100],χ^(2)=0.31,P=0.03

关 键 词：胃肿瘤 达芬奇机器人手术系统 腹腔镜胃切除术 疗效 并发症 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R735.2[自动化与计算机技术—控制科学与工程]