达芬奇机器人和腹腔镜应用于直肠癌根治术的临床疗效对比研究

Short-term outcomes comparison between robotic-assisted versus laparoscopic radical resection of rectal cancer

目的对比达芬奇机器人和腹腔镜应用于直肠癌根治术的可行性及近期疗效。方法回顾性分析2016年1月至2018年12月甘肃省人民医院肛肠科410例行直肠癌根治术患者的临床资料,其中达芬奇组215例,腹腔镜组195例,比较两组的手术情况、术后恢复情况、术后并发症及肿瘤学结果。结果机器人组手术出血量少于腹腔镜组[(107±46)ml比(147±35)ml,t=3.695,P<0.05],手术时间较长[(209±55)min比(195±55)min,t=2.508,P<0.05];术后通气时间早于腹腔镜组[(3.4±1.4)4比(5.3±1.6)d,t=-14.952,P<0.05],首次进食时间较早[(4.3±1.5)d比(6.2±2.6)d,t=-9.109,P<0.05];机器人组的淋巴结清扫数量多于腹腔镜组[(12.6±4.3)枚比(10.6±4.5)枚,t=4.468,P<0.05];机器人组的住院总费用高于腹腔镜组[(71775±45089)元比(66789±16721)元,t=4.224,P<0.05]。结论与腹腔镜手术相比,机器人手术治疗直肠癌出血量少、术后胃肠道功能恢复快、淋巴结清扫数量多。

Objective To compare effectiveness and short-term outcomes between robotic-assisted and laparoscopic surgery for radical resection of rectal cancer.Methods A total of 410 patients diagnosed with rectal cancer,undergoing robotic-assisted surgery(RAS)for rectal cancer(215 cases)and conventional laparoscopic surgery(CLS)for rectal cancer(195)from Jan 2016 to Dec 2018 were included into the present study.Operative characteristics,postoperative complications and pathologic parameters were evaluated between RAS and CLS group.Results The RAS group had less intraoperative blood loss[(107±46)ml(147±35)ml,t=3.695,P<0.05],longer operation time[(209±55)min(195±55)min,t=2.508,P<0.05],earlier first flatus[(3.4±1.4)d vs.(5.3±1.6)d,t=-14.952,P<0.05],and first liquid diet time[(4.3±1.5)d vs.(6.2±2.6)d,t=-9.109,P < O.05],more number of dissected lymph nodes[(12.6±4.3)vs.(10.6±4.5),t=4.468,P<0.05]compared with those in the CLS group.But more expensive total hospitalization costs[(71775±45089)yuan(66789±16721)yuan,t=4.224,P<0.05].Conclusion Compared with laparoscopic surgery,robotic-assisted surgery has less blood loss,shorter time of first flatus,more lymph nodes yield.