手术机器人系统与腹腔镜辅助胃癌切除术的临床疗效对比

Comparative study on clinical efficacy of robot-assisted and laparoscopic gastrectomy for gastriccancer

目的对比分析达芬奇手术机器人系统与腹腔镜辅助胃癌根治术的临床疗效。方法回顾性分析2009年1月至2011年12月南京军区南京总医院普通外科实施胃癌手术患者的临床资料。其中达芬奇手术机器人系统进行胃癌手术97例（机器人组），腹腔镜辅助胃癌手术70例（腹腔镜组）．对比分析两组患者的手术指标、病理指标及短期疗效指标。结果两组患者手术均顺利完成，无中转开腹病例。与腹腔镜组相比，机器人组患者术中出血量少[（80．8±53．1）比（153．7±26．4）ml，P=0．001]、淋巴结清扫数量多[（23．1±5．4）比（20．0±4．3）枚／例，P=0．001]、手术时间长[（272．3±46．1）比（240．3±89．1）min，P=0．003]、术后进食半流质时间早[（3．2±0．8）比（3．6±1．2）d，P=0．002]及住院时间短[（6．1±2．6）比（6．9±2．3）d，P=0．037]，差异均有统计学意义。两组患者近端切缘长度、远端切缘长度、术后下床时间、通气时间及术后并发症发生率的比较，差异均无统计学意义（均P〉0．05）。结论达芬奇机器人系统辅助胃癌手术安全可行，具有术中出血少、淋巴结清扫数多和术后康复快等优点．可取得与腹腔镜手术相同的肿瘤根治效果。

Objective To compare the clinical efficacy of robot-assisted procedure with laparoscopic surgery for gastric cancer. Methods The clinical data of patients who underwent gastrectomy in the Department of General Surgery in the Affiliated Jinling Hospital, Nanjing University Medical College from January 2009 to December 2011 were retrospectively analyzed. There were 97 patients undergoing robotic gastrectomy（ROB group） and 70 patients undergoing laparoscopic gastrectomy （LAP group）. The following parameters were compared between these two groups： intraoperative factors, oncologic outcomes, and short-term surgical outcomes. Results All the operations were performed successfully without conversion. Compared with the LAP group, the ROB group had less intraoperative blood loss [（80.8±53.1） vs. （153.7±26.4） ml, P=0.001], more number of lymph node dissection [（23.1±5.4） vs. （20.0±4.3）, P=0.001], longer operative time[（272.3±46.1） vs. （240.3±89.1） min, P= 0.001 ], earlier semifluid diet time[ （3.2±0.8） vs. （3.6±1.2） d, P=0.002], shorter postoperative hospital stay[ （6.1±2.6） vs. （6.9±2.3） d, P=0.037]. There were no significant differences in the length of distal and proximal margin, postoperative ambulation time, ventilation time and postoperative complications （all P〉0.05）. Conclusions The robotic gastreetomy is safe and feasible for gastric cancer. It has many advantages such as less blood loss, more number of lymph node dissection and quicker recovery. Similar radical resection can be achieved compared to laparoseopic gastrectomy.