单中心达芬奇机器人和腹腔镜下胃癌根治术的短期疗效和安全性的对比研究  

A comparative study on short-term efficacy and safety between da Vinci robotic and laparoscopic gastrectomy for gastric carcinoma in a single center

作　　者：张驰[1] 范义川 胡祥[1] Zhang Chi;Fan Yichuan;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：《中华普通外科杂志》2024年第10期752-757,共6页Chinese Journal of General Surgery

摘　　要：目的分析达芬奇机器人辅助胃癌根治术较传统腹腔镜手术在短期疗效和安全性方面是否具有优势。方法收集2020年12月至2024年4月在大连医科大学附属第一医院胃肠外科接受腹腔镜(n=121)和达芬奇机器人Xi系统辅助(n=126)的胃癌根治术247例患者的临床资料,比较两组患者术中情况及术后并发症发生情况。结果机器人手术组和腹腔镜手术组中位手术时间分别为300(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(10.0~12.0)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5(4~7)d和8(6~9)d,术后拔胃管中位时间分别为4(3~6)d和5(5~8)d,拔除引流管中位时间分别为8(6~10)d和10(9~12)d,术后中位住院时间分别为9(7~11)d和12(10~14)d,差异均有统计学意义(均P<0.05)。两组在近端切缘距离、远端切缘距离、淋巴结检出总数目、D1和D2淋巴结清扫数相比差异均无统计学意义(均P>0.05)。机器人手术组总并发症发生率为28.6%,低于腹腔镜手术组的40.5%,差异有统计学意义(χ^(2)=39.59,P<0.001)。机器人手术组手术及腹腔相关并发症更低(14.3%比33.9%,χ^(2)=13.04,P<0.001)。机器人手术组的Clavien-Dindo标准Ⅰ级并发症(χ^(2)=5.07,P=0.024)、Ⅱ级并发症(χ^(2)=4.41,P=0.036)比例更高。结论达芬奇手术系统辅助胃癌根治术安全可行,短期疗效较腹腔镜手术更具有优势。Objective To evaluate whether robotic gastrectomy using the da Vinci surgical system offers advantages over laparoscopic surgery in short-term outcomes and safety.Methods Clinical data were collected from 247 patients who underwent either laparoscopic or da Vinci Xi surgical system-assisted radical gastrectomy for gastric cancer at Department of Gastrointestinal Surgery,First Affiliated Hospital of Dalian Medical University between Dec 2020 and Apr 2024.Intraoperative indicators and postoperative complications were compared between the two groups.Results The operative time was 300(270-360)minutes in the robotic surgery group and 240(202-280)minutes in the laparoscopic group.Intraoperative blood loss was 20(10-30)ml and 30(10-50)ml,respectively.The incision length was 12.0(10.0-12.0)cm for the robotic group and 10.0(8.0-10.8)cm for the laparoscopic group.The first postoperative anal exhaust time was 4(3-5)days in the robotic group and 4(4-5)days in the laparoscopic group.The time to first intake of liquid diet was 5(4-7)days in the robotic group and 8(6-9)days in the laparoscopic group.The time to nasogastric tube removal was 4(3-6)days and 5(5-8)days,respectively.Drainage tube removal occurred at 8(6-10)days in the robotic group and 10(9-12)days in the laparoscopic group.The postoperative hospital stay was 9(7-11)days for the robotic group and 12(10-14)days for the laparoscopic group(all P<0.05).There were no statistically significant differences between the two groups in terms of proximal and distal resection margins,total number of dissected lymph nodes,or the dissection number of D 1 and D 2 lymph nodes(P>0.05).The overall complication rate was significantly lower in the robotic group(28.6%)compared to the laparoscopic group(40.5%)(χ^(2)=39.59,P<0.001).The lower complication rate in the robotic group was mainly due to a reduction in surgery-and abdomen-related complications(14.3%vs.33.9%,χ^(2)=13.04,P<0.001).The robotic group had a higher proportion of mild complications according to the Clavien-Dindo classi

关 键 词：胃肿瘤 胃切除术 机器人 腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]