摘要
目的 对比完全机器人与机器人辅助结肠癌根治术的短期临床疗效.方法 回顾性分析2016年8月至2023年12月于陆军军医大学大坪医院(陆军特色医学中心)普通外科接受机器人右半结肠癌或左半结肠癌根治术患者的临床资料,根据手术方式的不同,分为完全机器人组(n=49)和机器人辅助组(n=68).比较两组患者的一般资料、术中情况、术后并发症、术后恢复情况、住院费用、术后病理指标.结果 两组患者性别、年龄、身体质量指数、美国麻醉医师协会分级、肿瘤位置、腹部手术史比较差异无统计学意义(P＞0.05).所有患者均顺利完成手术,无邻近脏器损伤、意外大出血等术中严重并发症,两组均无中转腹腔镜或中转开腹病例.两组手术时间、术中出血量比较差异无统计学意义(P＞0.05).两组均无术后吻合口漏病例;完全机器人组中,1例(2.0％)术后发生乳糜漏,3例(6.1％)发生切口相关并发症,3例(6.1％)发生术后肠梗阻,无术后腹腔内出血病例,其他并发症3例(6.1％);机器人辅助组中,1例(1.5％)术后发生乳糜漏,4例(5.9％)发生切口相关并发症,1例(1.5％)发生术后肠梗阻,1例(1.5％)发生术后腹腔内出血,其他并发症4例(5.9％);两组首次排气时间、住院费用、术后并发症总发生率及并发症Clavien-Dindo分级比较差异无统计学意义(P＞0.05).完全机器人组的术后住院时间较机器人辅助组短(P＜0.05).两组的肿瘤分化程度、T分期、N分期、TNM分期、清扫淋巴结数目、阳性淋巴结数目比较差异无统计学意义(P＞0.05).结论 完全机器人结肠癌根治术安全可行,可缩短术后住院时间.但是,出于术者习惯、手术便捷程度、操作困难等方面的因素考虑,完全机器人结肠癌根治术目前仍然仅作为腹腔镜或机器人辅助手术的补充,该手术是否较传统机器人辅助手术更有优势及远期疗效仍需未来高级别的循证医学证据进一步验证.
Abstract
Objectives To compare the short-term outcomes of total robotic and robot-assisted radical resection for colon cancer.Methods A retrospective analysis was conducted on the clinical data of patients who underwent robotic right co-lon cancer or left colon cancer radical resection in the Department of General Surgery,Daping Hospital of Army Medical University(Army Medical Center)from August 2016 to december 2023.The patients were divided into a total robotic group(n=49)and a robot-assisted group(n=68)based on the surgical approach.The general information,intraopera-tive conditions,postoperative complications,postoperative recovery,hospitalization costs,and postoperative pathological in-dicators were compared between the two groups.Results There were no significant differences in gender,age,body mass index,American Society of Anesthesiologists classification,tumor location,or history of abdominal surgery between the two groups(P＞0.05).All surgeries were successfully completed without severe intraoperative complications such as adjacent organ injury or unexpected heavy bleeding.No conversions to laparoscopy or open surgery occurred in either group.There were no significant differences in operative time or intraoperative blood loss between the two groups(P＞0.05).No anastomotic leakage occurred in either group;in the total robotic group,1 patient(2.0％)developed chylous leakage,3 patients(6.1％)developed incision-related complications,3 patients(6.1％)developed postoperative intestinal obstruction,and no cases of postoperative intra-abdominal bleeding were observed.Other complications occurred in 3 pa-tients(6.1％).In the robot-assisted group,1 patient(1.5％)developed chylous leakage,4 patients(5.9％)developed incision-related complications,1 patients(1.5％)developed postoperative intestinal obstruction,1 patients(1.5％)devel-oped postoperative intra-abdominal bleeding,and other complications occurred in 4 patients(5.9％).There were no signifi-cant differences in the first exhaust time,hospitalization costs,overall postoperative complication rate,or Clavien-Dindo classification of complications between the two groups(P＞0.05).The postoperative hospital stay in the total robotic group was shorter than that in the robot-assisted group(P＜0.05).There were no significant differences in tumor differ-entiation,T stage,N stage,TNM stage,number of lymph nodes dissected,or number of positive lymph nodes between the two groups(P＞0.05).Conclusion Total robotic radical resection for colon cancer is safe and feasible,and can shorten the postoperative hospital stay.However,considering factors such as surgeon habits,surgical convenience,and op-erational difficulties,total robotic radical resection for colon cancer is still only a supplement to laparoscopic or robot-assisted surgery.Whether this procedure has advantages over traditional robot-assisted surgery and its long-term out-comes still require further verification by high-level evidence-based medical evidence in the future.
维普
万方数据