机器人与腹腔镜食管裂孔疝修补术对比研究  

A comparative study of robotic surgery versus laparoscopic repair of hiatal hernia

作　　者：刘明昊 李晨 王冰 万政 田文 Liu Minghao;Li Chen;Wang Bing;Wan Zheng;Tian Wen(Medicel School of Chinese PLA,Beijing 100853,China;Department of Thyroid&Hernia Surgery,Medical Department of General Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科,北京100853

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第4期376-382,共7页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：军队保健专项课题项目(21BJZ14)。

摘　　要：目的探讨食管裂孔疝患者采用机器人术式与腹腔镜术式进行食管裂孔修补的疗效。方法回顾性分析2015年3月至2024年4月,中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科收治的食管裂孔疝患者的临床资料。共计纳入128例患者,依据手术方法的不同,分为机器人组30例,腹腔镜组98例。统计患者术前基线资料、围手术期资料及术后症状改善情况。进一步通过年龄将患者进行分组,比较不同年龄的患者通过两种术式的获益情况。结果与腹腔镜组相比,机器人组患者术中出血量较少(20.0 ml比35.0 ml)、术后排气时间较短(2.0 d比3.0 d)、术后住院时间较短(4.0 d比5.0 d)、术后首日疼痛数字评定量表评分较低(3.0分比4.0分),而手术时间更长(120.0 min比101.5 min)、住院总费用更高(61564元比40407元),以上各项差异均有统计学意义(P<0.05)。术后中位随访时间51个月,2组患者症状均较术前得到改善。在中青年患者中,与腹腔镜组相比,机器人组患者术中出血量较少、术后排气时间短、手术时间较长、住院所需费用更多(分别为20.0 ml比32.5 ml,2.0 d比3.0 d,118.5 min比100.0 min,62200元比40027元),差异均有统计学意义(P<0.05);而在术后住院时间及疼痛情况并无明显获益(P>0.05)。在老年患者中,机器人组术中出血相对较少、术后排气时间及住院时间更短、术后疼痛评分更低、手术时间更长及住院费用相对较高(分别为20.0 ml比35.0 ml,2.0 d比3.0 d,4.0 d比5.0 d,3.0分比4.0分;120.0 min比110.0 min和60263元比40749元),差异均有统计学意义(P<0.05)。中青年患者及老年患者的术后症状均较术前缓解。结论不论是通过腹腔镜术式还是机器人术式,食管裂孔疝患者均可从手术中获益,两者相比,机器人术式可以为老年患者带来更明显的获益。Objective To investigate the efficacy of robot-assisted versus laparoscopic repair for patients with hiatal hernia(HH).Methods A retrospective analysis was conducted on the clinical data of patients with hiatal hernia treated in the Department of Thyroid&Hernia Surgery,Medical Department of General Surgery,the First Medical Center of Chinese PLA General Hospital from March 2015 to April 2024.A total of 128 patients were included and divided into two groups based on the surgical method:the robotic group(30 cases)and the laparoscopic group(98 cases).Preoperative baseline data,perioperative data,and postoperative symptom improvement were analyzed.Patients were further stratified by age to compare the benefits of the two surgical methods across different age groups.Results Compared to the laparoscopic group,the robot-assisted group exhibited less intraoperative bleeding(20.0 ml vs.35.0 ml),shorter postoperative gas evacuation(2.0 days vs.3.0 days),shorter postoperative hospitalization time(4.0 days vs.5.0 days),and lower pain numerical rating scale score on the first day after surgery(3.0 points vs.4.0 points),albeit with longer operative times(120.0 min vs.101.5 min)and higher total hospital costs(61564 yuan vs.40407 yuan),the above differences were statistically significant(P<0.05),During follow-up after surgery,symptoms improved in both groups of patients compared to preoperative conditions.Additionally,among young and mid aged patients,compared to laparoscopy,those in the robotic group experienced less intraoperative bleeding and shorter postoperative gas evacuation.However,robotic surgeries had longer operative times and incurred total hospital costs,with statistically significant differences(20.0 ml vs.32.5 ml,2.0 days vs.3.0 days,118.5 min vs.100.0 min,62200 yuan vs.40027 yuan;P<0.05).There were no significant benefits observed in terms of postoperative hospitalization time or pain scores(P>0.05).In elderly patients,robotic-assisted surgery is associated with significantly reduced intraoperative bleeding,short

关 键 词：食管裂孔疝 机器人手术 腹腔镜手术 疗效 

分 类 号：R655.4[医药卫生—外科学]