基于倾向性评分匹配的机器人经自然腔道取标本手术与机器人辅助直肠癌根治术的短期疗效比较  

Comparison of robotic natural orifice specimen extraction surgery and robotic-assisted surgery for radical resection of rectal cancer:a propensity score matching study

作　　者：叶善平 余宏鑫 胡惠宇 刘东宁[1] 吴灿 邹睿祥 何鹏辉[1] 李太原[1] Ye Shanping;Yu Hongxin;Hu Huiyu;Liu Dongning;Wu Can;Zou Ruixiang;He Penghui;Li Taiyuan(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Nanchang University Jiangxi Medical College,the First Clinical Medical College,Nanchang 330031,China)

机构地区：[1]南昌大学第一附属医院普通外科,南昌330006 [2]南昌大学江西医学院第一临床医学院,南昌330031

出　　处：《中华胃肠外科杂志》2024年第8期833-839,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：江西省卫健委科技计划项目(202310016)。

摘　　要：目的:比较机器人经自然腔道取标本手术(NOSES)与机器人辅助直肠癌根治术的短期疗效。方法:采用回顾性队列研究和倾向评分匹配(PSM)的研究方法,回顾性分析2018年6月至2024年3月于南昌大学第一附属医院行直肠癌根治术的547例患者的临床资料,其中机器人NOSES组157例,常规机器人组390例。采用PSM对直肠癌患者的术前一般资料[年龄、性别、体质指数、术前是否合并基础疾病、术前癌胚抗原异常(>6.5μg/L)、术前糖类蛋白199异常(>27 kU/L)、术前美国麻醉医师协会(ASA)分级、肿瘤长径、肿瘤距肛缘距离、TNM分期]进行1∶1匹配,卡钳值为0.05。PSM后,两组各纳入77例直肠癌患者,基线资料比较差异无统计学意义(均P>0.05)。主要比较机器人NOSES组与常规机器人组的手术情况、术后恢复情况、术后病理资料及术后并发症发生率。结果:与常规机器人组相比,机器人NOSES组术后首次排气时间更短[48(38,50)h比56(50,60)h,Z=-7.513,P<0.001],流质饮食时间更短[60(54,63)h比66(62,72)h,Z=-6.303,P<0.001]更短,且机器人NOSES组术后24 h视觉疼痛评分更低[3(3,4)分比4(4,5)分,Z=-5.237,P<0.001]、切口感染率更低[0比6.5%(5/77),χ^(2)=5.237,P=0.028],差异均有统计学意义(均P<0.05)。而两组在手术时间、术中出血量、术后住院时间、术后吻合口并发症和其他并发症发生率方面比较,差异均无统计学意义(均P>0.05)。结论:机器人NOSES手术治疗直肠癌安全、可行,术后恢复更快。Objective:To compare the surgical outcomes of robotic natural orifice specimen extraction surgery(NOSES)and robotic-assisted radical resection for rectal cancer.Methods:A retrospective analysis using propensity score matching(PSM)was conducted on 547 patients who had undergone radical resection of rectal cancer at the First Affiliated Hospital of Nanchang University from June 2018 to March 2024.The study cohort comprised 157 patients in the robotic NOSES group and 390 in the robotic-assisted group.PSM was used in a 1:1 manner to match relevant general clinical preoperative data of the study patients(age,sex,body mass index,preoperative comorbidities,abnormal preoperative carcinoembryonic antigen(>6.5μg/L)and carbohydrate antigen 19-9 levels(>27 kU/L),preoperative American Society of Anesthesiologists score,tumor diameter,tumor distance from the anal margin,and TNM stage),with a clamp value of 0.05.After performing PSM to match the general clinical data of the two groups of patients,77 patients in each of the robotic NOSES and robotic-assisted groups were included in the analysis.We found no statistically significant difference in preoperative general clinical data between the robot NOSES and robot-assisted groups(P>0.05).We compared the surgical outcomes,postoperative recovery,postoperative pathological data,and incidence of complications between the robotic NOSES and robot-assisted groups.Results:Compared with the robot-assisted groups.the robot NOSES group had a significantly shorter time to first postoperative passage of flatus(48[38,50]hours vs.56[50,60]hours,Z=-7.513,P<0.001),time to taking a liquid diet(60[54,63]hours vs.66[62,72]hours,Z=-6.303,P<0.001),lower pain scores(3[3,4]vs.4[4,5],Z=-5.237,P<0.001),and lower incision infection rates(0 vs.5[6.5%],χ^(2)=5.237,P=0.028)within 24 hours after surgery(P<0.05).However,there were no significant differences in surgical time,intraoperative blood loss,postoperative hospital stay,postoperative anastomotic complications,or incidence of other complications between

关 键 词：直肠肿瘤 机器人手术 经自然腔道取标本手术 短期疗效 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R735.37[自动化与计算机技术—控制科学与工程]