机器人辅助胃癌根治术的安全性及可行性分析

Analysis on safety and feasibility of robot-assisted radical gastrectomy

目的:探讨手术机器人在胃癌根治术中的安全性及可行性。方法:回顾性分析2016年1月~2019年3月在甘肃省普外临床医学中心行胃癌根治术282例患者的病例资料。行达芬奇机器人胃切除手术(Robot-assisted gastrectomy,RAG)者为RAG组(137例),行腹腔镜胃切除手术(Laparoscopy assisted gastrectomy,LAG)者为LAG组(145例)。比较两组患者的手术时间、术中出血量、淋巴结清扫数目等。按手术先后顺序对RAG组进行分组,确定机器人胃切除手术的学习曲线。结果:与LAG组比较,RAG组淋巴结清扫数目更多[(25.12±10.54)枚Vs(21.54±9.25)枚,P=0.03],术后住院时间更短[(13.36±3.00)d Vs(15.30±3.89)d,P<0.001]。而两组患者在手术时间、总并发症发生率、术中出血量方面,差异无统计学意义(P>0.05)。根据手术先后顺序对RAG组进行分组,经统计分析可知机器人胃切除手术的学习曲线为7例。结论:在胃癌根治术中,机器人手术术后恢复更快,淋巴结清扫更彻底,具备腹腔镜技术的医师更容易学习并掌握机器人手术。

Objective:To investigate the safety and feasibility of robot-assisted radical gastrectomy.Methods:Clinical data of 282 patients who underwent radical gastrectomy in the General Clinical Center of Gansu Provincial People’s Hospital from January 2016 to March 2019 was retrospectively analyzed,of which 137 patients underwent robot-assisted radical gastrectomy(RAG group)and 145 underwent laparoscopic-assisted radical gastrectomy(LAG group).The operation time,intraoperative blood loss and number of lymph node dissection were collected and compared between the two groups.Results:Compared with LAG group,the RAG group had a more number of lymph node dissection[(25.12±10.54)Vs(21.54±9.25),P=0.03]and shorter length of hospitalization[(13.36±3.00)d Vs(15.30±3.89),P<0.001].There was no significant difference in term of operation time,total incidence of complication and intraoperative blood loss between the two groups(P>0.05).Conclusion:Robot-assisted radical gastrectomy can dissect lymph node more thoroughly with a faster recovery after surgery.Doctors who is familiar with laparoscopic surgery can learn and master the robot-assisted surgical system easier.