达芬奇机器人与腹腔镜手术治疗老年结肠癌患者的临床疗效比较

Clinical effectiveness and safety of Da Vinci robotic versus laparoscopic surgery for elderly patients with colon cancer

目的比较达芬奇机器人与腹腔镜手术对老年结肠癌患者的安全性与临床疗效。方法回顾性分析2013年1月-2015年1月本院普通外科129例实施结肠癌根治手术且年龄> 70(78.0±4.9)岁患者的临床资料,其中行达芬奇机器人结肠癌根治术43例,腹腔镜结肠癌根治术86例,比较两组围术期指标及临床疗效。结果达芬奇机器人组与腹腔镜组性别、年龄、体质量指数(body mass index,BMI)、肿瘤位置等基线资料差异无统计学意义(P均> 0.05)。两组平均手术时间分别为(330.6±142.5) min、(214.5±42.73) min,住院费用为(9.63±1.61)万元、(6.30±1.77)万元,差异有统计学意义(P均<0.05);两组淋巴结清扫数、术后排气时间、术后进食时间、引流管及尿管留置时间、术后并发症发生率、3年总生存率等差异均无统计学意义(P均> 0.05)。结论对于70岁以上的结肠癌患者,机器人手术的安全性和临床疗效与腹腔镜手术相似,但手术时间更长、费用更高。

Objective To compare the safety and clinical effectiveness of Da Vinci robotic versus laparoscopic surgery for elderly patients with colon cancer.Methods Clinical data about 129 patients with age over 70 years(average age of 78.0±4.9 years)who underwent Da Vinci robotic radical colectomy(n=43)or laparoscopic radical colectomy(n=86)in department of general surgery,Chinese PLA General Hospital from January 2013 to January 2015 were retrospectively analyzed.Perioperative indicators and clinical outcomes were compared between the two groups.Results There was no significant difference in baseline data between two groups,such as age,sex,body mass index(BMI),tumor location and so on(all P>0.05).Compared with laparoscopic group,robotic group had longer operating time [(330.6±142.5)min vs(214.5±42.73)min,P=0.034]and higher hospitalization costs [(96.3±16.1)thousand yuan vs(63.0±17.7)thousand yuan,P=0.000].No significant difference was found in the number of retrieved lymph nodes,time to remove the urinary catheter and abdominal catheter,postoperative complications,time to flatus,time to oral intake,length of hospital stay,the overall and disease-free survival rates at 3 years after operation between two groups(all P>0.05).Conclusion In patients aged over 70 years,robotic colon surgery shows similar safety and clinical effectiveness to those obtained by laparoscopy,but longer operative time and higher costs.