基于倾向性评分匹配法的机器人与腹腔镜结肠癌根治术短中期疗效的比较  

Comparative analysis of short- and mid-term outcomes of robotic versus laparoscopic radical resection of colon cancer: a propensity score-matched cohort study

作　　者：郑恢超 李庆 童卫东 田跃 彭显月 李凡 黄彬 Zheng Huichao;Li Qing;Tong Weidong;Tian Yue;Peng Xianyue;Li Fan;Huang Bin(Department of Gastro-Colorectal and Anal Surgery,Daping Hospital,Army Medical University,Chongqing 400010,China;General Surgery Department,Shapingba Hospital of Traditional Chinese Medicine,Chongqing 400030,China)

机构地区：[1]陆军军医大学大坪医院(陆军特色医学中心)普通外科,重庆400010 [2]重庆市沙坪坝区中医院普通外科,重庆400030

出　　处：《中华胃肠外科杂志》2024年第8期816-823,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(82370547);重庆市自然科学基金面上项目(cstc2021jcyjmsxmX0477);重庆市科卫联合重点项目(2022ZDXM015)。

摘　　要：目的:比较机器人与腹腔镜右半与左半结肠癌根治术短中期临床疗效。方法:采用回顾性队列研究的方法,收集2015年1月至2023年12月期间,陆军军医大学大坪医院胃结直肠肛门外科两名高级职称医师实施的机器人或腹腔镜右半和左半结肠癌根治手术患者的临床资料,其中机器人手术组117例,腹腔镜手术组267例。采用倾向性评分匹配的方法按照1∶1的比例对两组进行匹配。倾向性评分匹配后,共有228例患者纳入本研究,机器人与腹腔镜手术组各114例;两组患者年龄分别为(60.8±12.1)岁和(60.3±13.1)岁,体质指数分别为(23.1±3.0)kg/m^(2)和(23.1±2.8)kg/m 2。两组基线资料的比较差异均无统计学意义(均P>0.05)。比较匹配后两组患者的术中术后情况以及3年生存结局等。结果:倾向性评分匹配后,机器人手术组共有右半结肠癌根治术80例,左半结肠癌根治术34例;腹腔镜手术组分别为78例和36例。所有患者均顺利完成手术,无邻近脏器损伤和意外大出血等术中并发症。与腹腔镜手术组比较,机器人手术组手术时间更长[(209.8±48.4)min比(186.7±46.9)min,t=3.665,P<0.001]、住院费用更高[(88657.8±18548.1)元比(61179.5±13822.7)元,t=12.683,P<0.001],而术后并发症发生率更低[7.9%(9/114)比17.5%(20/114),χ^(2)=4.780,P=0.029],差异均有统计学意义(均P<0.05)。机器人手术组未发生中转开腹,腹腔镜手术组中转开腹率为4.4%(5/114),但两组差异未达到统计学意义(χ^(2)=3.272,P=0.070)。两组术中出血量、术后首次排气时间、术后住院时间、术后并发症Clavien-Dindo分级、清扫淋巴结数目以及阳性淋巴结数目的差异均无统计学意义(均P>0.05)。机器人手术组与腹腔镜手术组3年无病生存率(81.4%比82.8%,P=0.863)、3年总生存率(83.1%比86.5%,P=0.921)比较,差异均无统计学意义(均P>0.05)。结论:机器人结肠癌根治术与腹腔镜手术相比,尽管其手术时间更长、住院费Objective:To compare the short-and mid-term clinical outcomes of robotic versus laparoscopic radical resection of right-and left-sided colon cancer.Methods:In this retrospective cohort study,clinical data on patients who had undergone robotic or laparoscopic radical resection of right and left sided-colon cancer performed by two senior physicians in the Department of Gastro-Colorectal and Anal Surgery,Daping Hospital,Army Medical University between January 2015 and December 2023 were collected.The patients were allocated to robotic(n=117)or laparoscopic groups(n=267).Propensity score matching in a ratio of 1∶1 was implemented to minimize the impact of imbalances in baseline information between the two groups.Propensity score matching left 228 patients in the study cohort,with 114 in each group.The participants were aged(60.8±12.1)and(60.3±13.1)years and the body mass indices were(23.1±3.0)kg/m 2 and(23.1±2.8)kg/m 2 in the robotic and laparoscopic groups respectively.After matching,relevant perioperative indicators,postoperative complications,and 3-year survival outcomes were compared between the two groups.Results:After propensity score matching,the differences in baseline information between the two groups were not statistically significant(P>0.05).After matching,in the robotic surgery group,radical resection of right-versus left-sided colon cancer had been performed on 80 and 34 patients,respectively;compared with 78 and 36,respectively,in the laparoscopic surgery group.Compared with the laparoscopic group,the robotic group had a longer operative time([209.8±48.4]minutes vs.[186.7±46.9]minutes,t=3.665,P<0.001),higher hospitalization cost([88657.8±18548.1]yuan vs.[61179.5±13822.7]yuan,t=12.683,P<0.001),and lower rate of postoperative complications(7.9%[9/114]vs.17.5%[20/114],χ^(2)=4.780,P=0.029);these differences are statistically significant.The robotic group tended to have a lower conversion rate than the laparoscopic group(0 vs.4.4%[5/114]);however,this difference between the two groups was not sta

关 键 词：结肠肿瘤 根治性手术 机器人手术 腹腔镜手术 疗效 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R735.35[自动化与计算机技术—控制科学与工程]