摘要
目的:探讨加速康复外科(enhanced recovery after surgery，ERAS)背景下，与腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy，LPD)相比，机器人手术系统应用的安全性、近期疗效和加速康复优势。方法:回顾性分析2015年3月至2022年3月南华大学附属第一医院88例应用机器人和腹腔镜手术系统行胰十二指肠切除术的患者临床资料。结果:所有患者手术均获成功，机器人组(38例)中位手术时间5.00 h(4.15 h，5.73 h)、中位术中出血量100.00 mL(50.00 mL，150.00 mL)，无中转开腹；术后1例出现腹腔感染；术后加速康复指标中，中位首次进食时间3.00 d(2.75 d，4.00 d)，中位首次排便时间5.00 d(4.00 d，6.00 d)，中位拔除全部引流管时间12.00 d(8.00 d，14.25 d)，中位术后住院时间13.50 d(9.75 d，16.00 d)。腹腔镜组(50例)中位手术时间8.00 h(7.50 h，8.70 h)，中位术中出血量200.00 mL(150.00 mL，200.00 mL)，7例中转开腹；术后10例出现腹腔感染；术后加速康复指标中，中位首次进食时间5.00 d(4.00 d，6.00 d)，中位首次排便时间6.00 d(5.00 d，6.00 d)，中位拔除全部引流管时间20.00 d(16.00 d，21.75 d)，中位术后住院时间19.50 d(17.00 d，29.25 d)。两组指标相比较，差异均有统计学意义(P<0.05)。结论:在ERAS背景下，机器人胰十二指肠切除术在手术安全性、并发症发生率和快速康复方面展现的优势相较于LPD更为明显。
Abstract
Objective:To explore the safety, short-term efficacy and advantages of robotic surgery system in pancreaticoduodenectomy.Methods:The clinical data of 88 patients with pancreatic diseases who underwent pancreaticoduodenectomy with da Vinci Robotics operation system and laparoscopic surgery system in the first affiliated Hospital of South China University from Mar. 2015 to Mar. 2022 were analyzed retrospectively.Results:All patients were operated successfully. In the robot group (38 cases), the median operation time was 5.00 h(4.15 h, 5.73 h), the median intraoperative blood loss was 100.00 mL (50.00 mL, 150.00 mL), 1 case had abdominal infection. Among the postoperative accelerated rehabilitation indexes, the median time of first feeding, defecation, drainage and hospital stay were 3.00 d(2.75 d, 4.00 d), 5.00 d(4.00 d, 6.00 d), 12.00 d(8.00 d, 14.25 d) and 13.50 d(9.75 d, 16.00 d) respectively. In the laparoscopy group (n=50), the median operation time was 8.00h and the median intraoperative blood loss was 200.00 mL (150.00 mL, 200.00 mL), 7 cases were converted to laparotomy, 10 cases had abdominal infection. Among the postoperative accelerated rehabilitation indexes, the median time of first feeding, defecation, drainage and hospital stay were 5.00 d(4.00 d, 6.00 d), 6.00 d(5.00 d, 6.00 d), 20.00 d(16.00 d, 21.75 d) and 19.50 d(17.00 d, 29.25 d) days respectively. There was significant difference in the above-mentioned indexes between the two groups (P<0.05).Conclusions:Under the background of enhanced recovery after surgery, RPD has more obvious advantages than LPD in operative safety, complications and rapid recovery.
基金项目
南华大学医学临床研究"4310"计划项目(20224310NHYCG01)
南华大学医学临床研究"4310"计划项目(20214310NHYPY05)
湖南省教育厅重点科研项目(21A0258)
湖南省自然科学基金(科卫联合项目)(2021JJ70039)
湖南省临床医疗技术创新引导项目(2020SK51817)
湖南省卫生健康委员会科技计划项目(20201064)
湖南省卫生健康委员会科技计划项目(20201919)
万方数据