机器人、腹腔镜与开腹手术治疗卵巢癌的疗效比较

Comparison of effects of robotic surgery,laparoscopy surgery and laparotomy in treatment of ovarian cancer

目的比较机器人、腹腔镜及开腹三种方式治疗卵巢癌全面分期手术患者的疗效。方法收集2013年1月1日-2018年12月31日于我中心接受卵巢癌全面分期手术患者共160例,按照手术方式不同,分为开腹组(75例)、腹腔镜组(52例)、机器人组(33例),比较三组患者围术期参数(手术时间、术中出血量、术中输血率、清扫淋巴结个数、术中并发症、术后发热及其他术后并发症、排气时间、病理类型),以及术后随访至2019年7月31日的复发情况。结果三组患者年龄、体质量指数、内科合并症及腹部手术差异均无统计学意义(P>0.05),具有可比性。三组患者在手术时间差异无统计学意义(P=0.111);术中出血量机器人组[(179.55±145.75)ml]及腹腔镜组[(229.71±162.49)ml]明显低于开腹组[(350.76±239.95)ml](P=0.000);术中输血率机器人组(18.19%)及腹腔镜组(19.23%)明显低于开腹组(42.67%)(P=0.000);清扫淋巴结数量机器人组(30.28±11.20)高于腹腔镜组(27.97±12.96)及开腹组(22.33±8.22)(P=0.004);术中并发症、发热情况及术后并发症三组差异无统计学意义(P均>0.05);术后排气时间腹腔镜组[(1.88±1.19)d]及机器人组[(2.38±1.13)d]早于开腹组[(2.70±0.96)d](P=0.000)。随访至2019年7月31日,三组患者术后的无进展生存期差异无统计学意义(P=0.185)。结论对于经过选择的患者,机器人及腹腔镜卵巢癌全面分期手术是安全可靠的。

Objective To study the effects of comprehensive staging operation via robotic laparoscopic surgery or laparotomy on patients with ovarian cancer.Methods From January 1,2013 to December 31,2018,160 patients with ovarian cancer underwent comprehensive staging operations in our hospital.According to the operation methods,the patients were divided into three groups,including laparotomy group(n=75),laparoscopy group(n=52)and robotic group(n=33).The perioperative parameters including operating time,intraoperative blood loss,intraoperative blood transfusion rate,number of lymph nodes resected,intraoperative complications and postoperative fever and other postoperative indicators such as exhaust time and pathological types,and the recurrence data from postoperation to July 31st,2019 were compared between the three groups.Results There was no significant difference in age,BMI,medical complications and abdominal surgery history between the three groups.No significant difference was found in operating time between the three groups(P=0.111).The intraoperative blood loss in the robotic group and the laparoscopy group was significantly lower than that in the laparotomy group[(179.55±145.75)ml and(229.71±162.49)ml vs(350.76±239.95)ml,P=0.000].The intraoperative blood transfusion rate in the robotic group and the laparoscopy group was significantly less than that in the laparotomy group(18.19%and 19.23%vs 42.67%,P=0.000).The number of lymph nodes resected in the robotic group was higher than that in the laparoscopy group and the laparotomy group[(30.28±11.20)vs(27.97±12.96)and(22.33±8.22),P=0.004].There was no statistically significant difference in intraoperative complications,postoperative fever and other postoperative indicators between the three groups(all P>0.05).The postoperative exhaust time in the laparoscopy group and the robotic group was earlier than that of the laparotomy group[(1.88±1.19)d and(2.38±1.13)d vs(2.70±0.96)d,P=0.000].The follow-up was lasted to July 31,2019,and there was no significant difference in progress free survival between the three groups(P=0.185).Conclusion Robotic surgery and laparoscopic surgery in comprehensive staging operation are safe and effective in selected patients with ovarian cancer.