达芬奇机器人对比腹腔镜在低位直肠癌APR手术中盆底腹膜关闭联合腹膜外造口的应用研究

A study of the Da Vinci robot contrast laparoscopy in APR surgery for low rectal cancer with pelvic floor peritoneal closure combined with extraperitoneal stoma

目的探讨达芬奇机器人对比腹腔镜关闭盆底腹膜联合腹膜外造口在低位直肠癌腹会阴联合切除术(APR)中的应用效果。方法回顾性分析2019年5月~2022年5月在江苏省苏北人民医院胃肠中心实施APR手术的低位直肠癌患者临床资料,按手术方式分为RAPR组(达芬奇机器人手术28例)和LAPR组(腹腔镜手术31例)。结果两组术中出血量、首次排气排便时间、引流管拔出时间、尿管拔出时间、住院时间、肿瘤直径、肿瘤分化程度、TNM分期、术后造口并发症、术后部分会阴部并发症及男性性功能方面比较,差异无统计学意义(P>0.05),RAPR组相比于LAPR组,手术时间长(185.2±36.1 min vs.153.5±34.2 min,t=3.467,P=0.001),淋巴结清扫数目多(16.5±3.8枚vs.14.3±3.5枚,t=2.322,P=0.024)、会阴切口感染率低(7.1%vs.29.0%,χ^(2)=4.647,P=0.045)、会阴切口裂开率低(3.6%vs.25.8%,P=0.027),患者术后夜尿次数少(1.00±0.82次vs.1.48±0.89次,t=-2.169,P=0.034)、排尿功能好(P=0.026)。结论运用达芬奇机器人进行盆底腹膜关闭联合腹膜外造口是安全可行的,可提高淋巴结清扫数目,降低部分会阴部并发症发生率,患者术后夜尿次数少,排尿功能好,在临床中具有一定的实用价值。

Objective Exploring the effect of Da Vinci robot contrast laparoscopy to close the pelvic floor peritoneum combined with extraperitoneal stoma in abdominoperineal resection(APR)for low rectal cancer.Methods The clinical data of patients with low rectal cancer who underwent APR surgery at Gastrointestinal Center of Northern Jiangsu People's Hospital from May 2019 to May 2022 were retrospectively analyzed and divided into RAPR group(28 cases of Da Vinci robot surgery)and LAPR group(31 cases of laparoscopic surgery)according to the surgical method.Results There were no statistically significant differences in intraoperative bleeding,time to first defecation,time to drainage tube removal,time to urinary catheter removal,hospital stay,tumor diameter,tumor differentiation degree,TNM stage,postoperative stoma complications,some postoperative perineal complications and male sexuality between the two groups(P>0.05),and the RAPR group had a longer operative time compared to the LAPR group(185.2±36.1 min vs.153.5±34.2 min,t=3.467,P=0.001),and also improved the number of lymph node dissection(16.5±3.8 vs.14.3±3.5,t=2.322,P=0.024),and have a low rate of perineal incision infection(7.1%vs.29.0%,χ^(2)=4.647,P=0.045),low rate of perineal incision dehiscence(3.6%vs.25.8%,P=0.027),and patients had less postoperative nocturnal urination(1.00±0.82 vs.1.48±0.89,t=-2.169,P=0.034)and better voiding function(P=0.026).Conclusion The use of the Da Vinci robot for pelvic floor peritoneal closure combined with an extraperitoneal stoma is safe and feasible,and can improve the number of lymph nodes cleared and reduce the incidence of some complications,and provide patients with fewer postoperative nocturnal urinations and better voiding function,which has some practical value in clinical practice.