机器人腹腔镜下腹股沟淋巴结切除术在外阴癌治疗中的近期疗效研究

Study on short-term efficacy of robotic-assisted laparoscopic inguinal lymphadenectomy in the treatment of vulvar cancer

目的:研究机器人腹腔镜下腹股沟淋巴结切除术在外阴癌治疗中的近期疗效。方法:回顾性分析2009年10月~2019年12月中南大学湘雅三医院因外阴癌行腹股沟淋巴结切除术50例患者的临床病理资料,根据手术方式分为开放组、腹腔镜组及机器人组。比较三组患者平均每侧腹股沟淋巴结切除术术中出血量、手术时间、切除淋巴结个数、术后引流管留置时间、术后腹股沟切口和淋巴相关并发症发生情况,以及三组患者平均术后住院时间,从而明确各种手术方式的近期疗效差异。结果:50例患者共进行了99侧腹股沟淋巴结切除术,所有患者均顺利完成手术,无严重术中并发症发生,腹腔镜组及机器人组患者无中转开放手术病例。三组患者比较,术中每侧切除腹股沟淋巴结个数比较,差异无统计学意义(P=0.627)。在手术时间方面,机器人组每侧腹股沟淋巴结切除术手术时间较腹腔镜组及开放组延长(P<0.05),但进一步分析发现前5例(10侧)机器人腹腔镜下腹股沟淋巴结切除术中耗时明显较后12例(23侧)患者长,差异有统计学意义(P<0.05),且后者与开放组及腹腔镜组相比,差异无统计学意义(P=0.113)。此外与开放组相比,腹腔镜组及机器人组平均出血量明显减少,术后腹股沟切口引流管放置时间明显缩短,差异均具有统计学意义(P<0.05);且与开放组相比较,机器人组每侧腹股沟淋巴切除术后出现切口并发症几率更低(P<0.017),每位患者平均术后住院时间更短(P<0.05)。但三组患者比较术后出现淋巴相关并发症差异无统计学意义(P>0.017)。此外,与腹腔镜组相比,机器人组每侧腹股沟淋巴结切除术中出血量更少,术后引流管留置时间更短,差异均具有统计学意义(P<0.05),其余各方面组间比较,差异无统计学意义(P>0.05/P>0.017)。结论:腹腔镜及机器人腹腔镜是外阴癌腹股沟淋巴结切除术更为微创的手术方式,且与腹腔镜相比,机器人腹腔镜更具有一定的优势。

Objective:To study the short-term efficacy of robotic laparoscopic inguinal lymphadenectomy in the treatment of vulvar cancer.Methods:Analysis retrospectively the clinical data of 50 cases of vulvar cancer undergoing inguinal lymphadenectomy from October 2009 to December 2019 in the Third Xiangya Hospital of Central South University.According to the operation methods,the patients were divided into open group,laparoscopic group and robotic group.By comparing the average amount of bleeding,operation time,number of lymph nodes removed,retention time of drainage tube after operation,the incidence rate of postoperative complication related to wounds and lymphatic in each side of inguinal lymphadenectomy,and the average postoperative hospitalization of each group’s patients,the short-term efficacy of the three operative methods were clarified.Results:99 sides of inguinal lymphadenectomy were performed on 50 patients.All the patients successfully completed the operation found no serious complications during the operation.There was no conversion to open surgery in laparoscopic group and robotic group.There was no difference in the average number of lymph nodes excised in each side of inguinal lymphadenectomy between the three groups(P=0.627).Although the operation time of robotic group was longer than that of laparoscope group and open group(P<0.05),further analysis showed that the operation time of robotic group of the first 5 patients(10 sides)was significantly longer than that in the last 12 patients(23 sides)with a statistically significant difference,and the difference between the last 12 patients in the three groups was not statistically significant(P=0.113).Besides,compared with the open group,the laparoscopic group and the robotic group had a lower average amount of bleeding and the average placement days of the drainage tube of the groin incision,and the differences were statistically significant(P<0.05).However,as for the incidence of lymphatics related complications,there was no significant difference between the three groups(P>0.017).In addition,compared with the laparoscopic group,the robotic group had less intraoperative bleeding and shorter postoperative drainage tube retention time,the differences were statistically significant(all P<0.05),but there were no significant differences between the two groups in other aspects(P>0.05/P>0.017).Conclusion:laparoscopic and robot-assisted laparoscopic inguinal lymphadenectomy are more minimally invasive methods for vulvar cancer,and compared with laparoscopy,robot-assisted laparoscopy has more advantages in inguinal lymphadenectomy.