机器人外科手术系统与传统腹腔镜辅助结直肠癌根治术的初步比较

Robot-assisted resection of colorectal cancer:a comparison of preliminary results with traditional laparoscopic

目的初步比较机器人外科手术系统与传统腹腔镜辅助结直肠癌根治手术在技术上的差异及手术结果。方法 2010年3—10月,将肿瘤生长部位分别为升结肠、左半结肠、乙状结肠和直肠的10例患者非随机两两配对,分别采用传统腹腔镜技术(腔镜组)和达芬奇机器人外科手术系统(机器人组)辅助完成结直肠癌根治手术,即右半结肠切除、左半结肠切除、乙状结肠癌根治、直肠上段癌行直肠前切除和低位直肠癌行直肠前切除各2例。比较两组的手术时间、术中出血量、术后恢复及肿瘤学治疗评价。结果两组患者均顺利完成手术,无中转开腹病例。机器人组的手术时间略长于腹腔镜组,术中出血量略少于腹腔镜组,但差异均无统计学意义(P值均>0.05)。两组术后恢复情况相似。手术后标本的肿瘤病理学检查都达到根治性肿瘤学手术的要求,仅1例低位直肠癌行腹腔镜直肠前切除手术的患者的系膜完整性被破坏。结论达芬奇机器人外科手术系统辅助结直肠癌根治术更能体现微创外科的损伤控制原则和肿瘤治疗原则,尤其在狭窄盆腔的低位直肠癌根治术方面有着广阔的应用前景。

Objective To compare the techniques and outcomes of conventional laparoscopic resection for colorectal cancer and robotic assisted resection for colorectal cancer.Methods From March 2010 to October 2010,10 patients with tumor on the ascending colon,left colon,sigmoid colon and rectum were treated by conventional laparoscopic techniques and Da Vinci robot-assisted surgery.The surgeries included right hemicolectomy in 2 cases,left hemicolectomy in 2 cases,low anterior resection of upper rectum on rectal cancer in 2 cases,and low anterior resection of the rectum on lower rectal cancer in 2 cases.The operation time,blood loss,postoperative recovery and evaluation of oncology treatment were compared between the two groups. Results All surgeries were successfully done without conversion.The operation time was longer in robot-assisted surgery group than in laparoscopic surgery group,but the blood loss was less than in laparoscopic surgery group. The postoperative recovery was similar between the two groups.Postoperative pathological examination of tumor specimens showed radical resection in all patients,with one case of low rectal cancer had damaged mesorectum after treated by laparoscopic technique.Conclusion The Da Vinci robot-assisted resection of colorectal cancer can better reflect the principles of damage control of minimally invasive surgery and cancer treatment guidelines;it especially has a promising future in resection of narrow pelvic rectal cancer.