基于倾向性评分匹配法对比类腹腔镜“3臂+2孔”模式与传统“4臂+1孔”模式机器人辅助远端胃癌根治术围手术期疗效研究  

Comparison of perioperative efficacy between laparosopic-like"3-arm+2-port"model and traditional"4 arm+1-port"model in robot-assisted radical distal gastrectomy based on propensity score matching

作　　者：沈枭垚 张业骞 张圃华 赵恩昊[1] 朱纯超[1] 王争[1] 曹晖[1] 夏翔 张子臻[1] SHEN Xiao-yao;ZHANG Ye-qian;ZHANG Pu-hua;ZHAO En-hao;ZHU Chun-chao;WANG Zheng;CAO Hui;XIA Xiang;ZHANG Zi-zhen(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200120

出　　处：《中国实用外科杂志》2025年第1期109-112,120,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金基金项目(No.82173215,82103510,82473077,82473065);上海市“医苑新星”项目(No.2022-65);上海市卫生健康委员会卫生行业临床研究专项No.(202140458);上海市自然科学基金项目(No.22ZR1438800,23ZR1439400);仁济医院培育基金项目(No.RJTJ22-MS-025)。

摘　　要：目的探讨类腹腔镜“3臂+2孔(3+2)”模式相比传统“4臂+1孔(4+1)”模式达芬奇机器人辅助远端胃癌根治术在手术效率、术后恢复以及卫生经济学等方面的优势。方法回顾性分析2023年3月1日至2024年11月30日上海交通大学医学院附属仁济医院胃肠外科收治的192例接受达芬奇机器人辅助胃癌根治术的病人,按手术模式分为传统“4+1”组(n=38),类腹腔镜“3+2”组(n=154)。通过倾向性评分匹配法(propensity score matching,PSM)按1∶2匹配后比较两组病人围手术期相关指标。结果PSM匹配后,相较于传统“4+1”组,类腹腔镜“3+2”组在手术总体时间[(221.1±32.93)min vs.(244.9±27.77)min],大网膜切除时间[(19.5±1.86)min vs.(26.1±3.28)min],No.11p、8a、7、9[(20.8±2.18)min vs.(22.3±4.01)min],No.1、3[(21.1±1.33)min vs.(23.4±5.73)min]淋巴结清扫时间,装机时间[(10.5±1.05)min vs.(12.2±1.81)min],脏器牵拉调整时间[(11.5±1.05)min vs.(13.2±1.73)min]方面均更短,且类腹腔镜“3+2”模式组避免了同侧机械臂激活与锁定的切换[(0±0.0)次vs.(161±53.2)次,P<0.001],No.4sb淋巴结清扫个数更多[(5.4±1.31)个vs.(4.7±1.46)个],差异均具有统计学意义(P<0.05)。两组在No.4sb、No.6、No.5、12淋巴结清扫时间,镜头调整时间,术中出血量,以及No.6、No.5、12、No.11p、8a、7、9、No.1、3淋巴结清扫个数方面差异均无统计学意义(均P>0.05)。此外,类腹腔镜“3+2”组的耗材成本[(34956.1±2835.19)元vs.(38688.9±1478.61)元]更低,差异具有统计学意义(P<0.05)。结论类腹腔镜“3+2”模式不仅降低了经济成本,提高了手术效率,而且具有缩短学习曲线、降低手术难度、利于术者配合等优点,尤其适合具备丰富腹腔镜手术经验的团队开展。Objective To explore the advantages of the"3-arm+2-port(3+2)"model over the traditional"4-arm+1-port(4+1)"model in da Vinci robot-assisted radical distal gastrectomy for gastric cancer.Methods A retrospective analysis was conducted on 192 patients who underwent da Vinci robot-assisted radical gastrectomy for gastric cancer at Renji Hospital,Shanghai Jiao Tong University School of Medicine from March 1st,2023,to November 30th,2024.After propensity score matching(PSM)at a ratio of 1∶2,perioperative variables were compared between the two groups.Results After PSM,compared to the traditional"4+1"group,the laparoscopic-like"3+2"group showed shorter overall operation time[(221.1±32.93)min vs.(244.9±27.77)min],omentectomy time[(19.5±1.86)min vs.(26.1±3.28)min],lymph node dissection time for No.11p,8a,7,and 9[(20.8±2.18)min vs.(22.3±4.01)min],No.1 and 3[(21.1±1.33)min vs.(23.4±5.73)min],setup time[(10.5±1.05)min vs.(12.2±1.81)min],and organ retraction and adjustment time[(11.5±1.05)min vs.(13.2±1.73)min].Moreover,the laparoscopic-like"3+2"model group avoided switching between activation and locking of the same-side robotic arms[(0±0.0)times vs.(161±53.2)times,P<0.001],and had a higher number of dissected No.4sb lymph nodes[(5.4±1.31)vs.(4.7±1.46)],with all differences being statistically significant(P<0.05).Additionally,the laparoscopic-like"3+2"group had lower consumable costs[(34956.1±2835.19)CNY vs.(38688.9±1478.61)CNY],with differences being statistically significant(P<0.05).Conclusion The laparoscopic-like"3+2"model for Da Vinci robot-assisted radical distal gastrectomy not only reduces economic costs and improves surgical efficiency but also offers advantages such as shortening the learning curve,reducing surgical difficulty,and facilitating better cooperation among surgeons.

关 键 词：胃癌 远端胃癌根治术 机器人手术 手术时间 

分 类 号：R6[医药卫生—外科学]