达芬奇机器人与腹腔镜直肠癌全直肠系膜切除术短期应用效果的比较

Short-term outcomes of robotic vs.laparoscopic total mesorectal excision for rectal cancer

目的比较达芬奇机器人与腹腔镜直肠癌全系膜切除术的近期疗效。方法回顾性分析2017年6月至2019年6月甘肃省人民医院肛肠科达芬奇机器人(机器人组135例)和腹腔镜(腹腔镜组120例)直肠癌全系膜切除术患者的临床资料,比较2组术中、术后及随访情况等。结果机器人组术中出血量少于腹腔镜组[(127±33)ml比(165±48)ml,f=1.931,P=0.032];机器人组术后排气时间早于腹腔镜组[(79.6±23.4)h比(118.5±27.6)h,f=0.367,P<0.001];机器人组术后首次流质饮食时间早于腹腔镜组[(90.8±16.7)h比(1Z3.1±20.8)h,t=-1.128,P=0.043];机器人组术后住院时间短于腹腔镜组[(9.1±3.1)d比(10.9±3.9)d,-4.150,P<0.001];机器人组住院总费用多于腹腔镜组[(78879±15454)元比(65966±17078)元,t=3.174,P=0.013]。2组手术时间、引流管留置时间、淋巴结清扫效果、病理学结果及术后并发症差异均无统计学意义(均P>0.05)。结论达芬奇机器人直肠癌全系膜切除术具有出血量少、胃肠道功能恢复快、住院时间短等优势。

Objective To compare short-term outcomes between robotic and laparoscopic total mesorectal excision(TME)for rectal cancer.Methods A retrospective cohort study was performed.The data of patients diagnosed with rectal cancer,undergoing da Vinci robotic(robot group,n=135)or laparoscopic(laparoscopy group,n=20)total mesorectal excision at our hospital from June 2017 to June 2019 were analyzed,and the intraoperative,postoperative and follow-up results of the two groups were compared.Results Compared to the laparoscopy group,the robot group had less blood loss[(127±33)ml vs.(165±48)ml,t=1.931,P=0.032],earlier flatus[(79.6±23.4)h vs.(118.5±27.6)h,t=0.367,P<0.001],earlier eating[(90.8±16.7)h us.(123.1±20.8)h,t=-1.128,P=0.043],shorter postoperative hospital stay[(9.1±3.1)d us.(10.9±3.9)d,t=-4.150,P<0.001],but higher costs[(78879±15454)CNY us.(65966±17078)CNY,t=3.174,P=0.013].There were no significant differences between the two groups in operation time,abdominal drainage time,lymph node dissection,pathological results and postoperative complication rate(all P>0.05).Conclusion Robotic-assisted total mesorectal excision for rectal cancer is safe and effective,and has the advantages of less blood loss,faster recovery of gastrointestinal function and shorter hospital stay.