机器人辅助与传统Ivor-Lewis食管癌根治术近期疗效的比较

Robotic-assisted Versus Open Ivor-Lewis Esophagectomy for Esophageal Cancer: a Comparative Study on Short-term Results

目的探讨机器人辅助手术与传统Ivor-Lewis食管癌根治术的短期疗效。方法 2015年1~9月,同一外科团队手术治疗36例食管癌,其中传统手术19例,机器人辅助手术17例。2组一般资料差异无统计学意义。回顾性比较2组手术相关资料、术后短期疗效的差异。结果机器人组手术时间长于传统组[（333.5±85.0）min vs.（203.9±24.8）min,t=6.357,P=0.000];手术出血量机器人组为（182.3±78.9）ml,传统组为（195.3±149.2）ml,差异无统计学意义（t=-0.319,P=0.752）。2组均R0切除,切端阴性。食管标本长度机器人组为（8.2±2.1）cm,传统组为（8.6±1.6）cm,差异无统计学意义（t=-0.654,P=0.518）;淋巴结清扫数量机器人组为（17.4±7.7）枚,传统组为（20.0±9.1）枚,差异无统计学意义（t=-0.913,P=0.367）。术后住院时间机器人组显著少于传统组[（9.8±2.0）d vs.（12.6±5.5）d,t=-2.076,P=0.046]。术后并发症机器人组2例,传统组5例,差异无统计学意义（P=0.408）。2组术后30天内均无死亡病例。结论机器人辅助Ivor-Lewis手术的根治性与传统手术相当,术后恢复较传统手术快,并发症不多于传统手术,其短期疗效有待进一步大样本研究验证。

Objective To compare short-term results between robotic-assisted and open Ivor-Lewis esophagectomy for the treatment of esophageal cancer. Methods From January 2015 to September 2015,36 patients with esophageal cancer underwent esophagectomy in our hospital,including 17 cases of robotic-assisted Ivor-Lewis esophagectomy（ robotic group） and 19 cases of open Ivor-Lewis esophagectomy（ open group）. There was no difference between the two groups in perioperative clinical data. A retrospective comparison was carried out between the two groups in operative data and short-term results. Results The operative time was significantly longer in the robotic group than in the open group [（ 333. 5 ± 85. 0） min vs.（ 203. 9 ± 24. 8） min,t = 6. 357,P =0. 000]. There was no significant difference in the operative blood loss between the robotic group（ 182. 3 ± 78. 9 ml） and the open group（ 195. 3 ± 149. 2 ml,t =- 0. 319,P = 0. 752）. All the patients received R0 resection,and the margins were all negative. The length of specimens was（ 8. 2 ± 2. 1） cm in the robotic group and（ 8. 6 ± 1. 6） cm in the open group,without significant difference（ t =- 0. 654,P = 0. 518）. The number of lymph nodes harvested was 17. 4 ± 7. 7 in the robotic group and was 20. 0 ± 9. 1 in the open group,without significant difference（ t =- 0. 913,P = 0. 367）. The postoperative hospital stay was significantly shorter in the robotic group than in the open group [（ 9. 8 ± 2. 0） d vs.（ 12. 6 ± 5. 5） d,t =- 2. 076,P = 0. 046]. Postoperative complications were found in 2 cases in the robotic group and 5 cases in the open group,the difference being not significant（ P = 0. 408）. No death was found in30 days after operation in both groups. Conclusions Robotic-assisted Ivor-Lewis esophagectomy for esophageal cancer is safe and equivalent to open surgery in radical results. It has shorter recovery time and less postoperative complications than open surgery.However,its short-term results need to be tested by further larger-sample studies.