机器人肝切除术与腹腔镜肝切除术的疗效比较

Comparison between robotic liver resection and laparoscopic liver resection

目的:配对比较机器人与传统腹腔镜肝切除的术中及术后结果,评价机器人肝切除术的安全性和优势。方法:对我院2010年3月至2017年8月实施的88例微创肝切除术病人的资料进行回顾性分析,按手术方式的不同分为机器人组(n=44)和腹腔镜组(n=44)。采用倾向匹配分析方法,按照1∶1的比例,根据病人的性别、年龄、有无肝炎和肝硬化、体质量指数、美国麻醉师协会分级、肝脏切除范围在机器人组病人中进行配对。结果:两组病人的术中出血量、术中输血率、术后住院时间、术后并发症发生率和R0切除率无统计学差异。机器人组手术时间较腹腔镜组长[(183.36±64.40)min比(156.25±71.53)min,P=0.013]。但与腹腔镜组相比,机器人组中转开腹率较低(4.5%比22.7%,P=0.013)。结论:虽然机器人肝切除手术时间较长,但中转开腹率较低,与传统腹腔镜肝切除术具有相似的安全性。

Objective To perform a matched comparison of surgical and postsurgical outcomes between robotic and laparoscopic liver resections（LLR） and evaluate the advantages of robotic liver resections（RLR）.Methods Clinical outcomes among patients undergoing RLR（n=44） and LLR（n=44） in our hospital between March 2010 and August 2017 were reviewed.A 1∶1 matched analysis was performed using propensity score matching between patients in RLR group and pa-tients in LLR group based on gender,age,hepatitis,cirrhosis,body mass index,American Society of Anesthesiologists grade and the extent of liver resections.Results Matched patients undergoing robotic and laparoscopic liver resections dis-played no significant differences in blood loss,transfusion rate,hospital stay,postsurgical complications and R0 resection rate.RLR was associated with longer operative time,（183.36 ±64.40） min vs（156.25±71.53） min,P=0.013.The conversion rate in RLR group was lower than in LLR group（4.5% vs 22.7%）,P=0.013.Conclusions Lower conversion rate of RLR was observed when compared with LLR in spite of longer operative time.RLR and LLR had similar safety and feasibility.