达芬奇机器人在根治性胃癌手术中的应用疗效研究

Curative effect of Da Vinci robot assisted radical gastrectomy for gastric cancer

目的研究达芬奇机器人在胃癌根治术中的使用价值.方法收集中国人民解放军兰州总医院普外科自2016-12/2017-04接受达芬奇机器人胃癌根治术的患者信息,以同期接受腹腔镜胃癌根治术患者信息做对照,将二组手术治疗效果、术后恢复情况、住院费用以及预后等信息行统计分析.结果相比于腹腔镜组,达芬奇组术中出血少(P<0.05)、淋巴结清扫彻底(P<0.0 5)、手术切缘更安全(P<0.05),但手术时间会增加(P<0.05);而在患者的术后恢复中,二组术后首次进食、消化道功能恢复所需时间以及手术并发症的发生率均未见明显差异(P>0.05),而手术费用却会明显增加(P<0.05);但接受达芬奇根治性全胃手术的患者术后住院日明显低于腹腔镜组(P<0.05),而这种差异在根治性远侧胃切除术患者中却并未发现(P>0.05);另外,二组患者术后的远期生存情况并未明显的差异(P>0.05).结论达芬奇机器人在外科手术中的使用确实存在一定优势,但仍需要术者不断提升自身技能并慎重对待.

AIM To assess the value of Da Vinci robot in radical gastrectomy for gastric cancer.METHODS The information of patients who underwent Da Vinci robot assisted radical gastrectomy for gastric cancer at the Department of General Surgery, Lanzhou General Hospital of the Chinese People＇s Liberation Army from December 2016 to April 2017 was collected. The information of patients who received laparoscopic radical gastrectomy for gastric cancer was also obtained. The information on surgical treatment, postoperative recovery, hospital expenses, and prognosis was statistically analyzed between the two groups. RESULTS Compared with the laparoscopic group, the Da Vinci group had less bleeding during operation（P〈0.05）, more complete lymph node dissection（P〈0.05）, and safer incision margin（P〈0.05）, but the operative time was increased（P〈0.05）. In the postoperative recovery of patients of the two groups, the time to first food intake, the time to the recovery of the digestive tract, and the incidence of complications were not significantly different between the two groups（P〉0.05）, but surgical cost was significantly increased（P〈0.05）. The hospital stay was significantly shorter in patients who received Da Vinci robot assisted radical gastrectomy than in the laparoscopy group（P〈0.05）, but this difference was not found in patients who underwent distal radical gastrectomy（P〉0.05）. There was no significant difference in long-term survival between the two groups（P〉0.05）.CONCLUSION Da Vinci robot assisted radical gastrectomy has certain advantages over laparoscopic radical gastrectomy in the treatment of gastric cancer, but it is still necessary for practitioners to improve their skills and be cautious.