达芬奇机器人和腹腔镜根治肥胖直肠腺癌患者的临床效果对比

Comparison of clinical effects of Da Vinci robotic and laparoscopic radical resection for obese patients with rectal adenocarcinoma

目的对比分析机器人和腹腔镜辅助直肠癌根治术治疗肥胖直肠腺癌患者的治疗效果。方法采用回顾性队列研究方法,收集2017年10月至2020年1月期间在郑州大学第一附属医院结直肠肛门外科接受手术治疗的肥胖直肠腺癌患者的临床病理资料,根据手术方式分为达芬奇机器人辅助直肠癌根治术组(机器人组)和腹腔镜辅助直肠癌根治术组(腹腔镜组)。观察2组患者的围术期相关指标及术后泌尿生殖功能恢复情况。结果本研究共收集到符合纳入和排除标准的肥胖直肠腺癌患者共217例,机器人组104例,腹腔镜组113例。2组患者在性别、年龄、体质量指数、肿瘤下缘距肛缘距离、肿瘤直径,美国麻醉医生协会分级、术前合并症、术前癌胚抗原水平、肿瘤分化程度、TNM分期等基线资料比较差异均无统计学意义(P>0.05)。2组患者均顺利完成手术,无中转开腹及围术期死亡病例。2组患者的手术时间、首次排气时间、首次进食流食时间、首次下床活动时间、放置引流管时间、预防性造口率及术后并发症比较差异均无统计学意义(P>0.05),机器人组的术中出血量及总住院时间少(短)于腹腔镜组(P<0.05)。机器人组术后3、6及12个月的国际前列腺症状评分均低于腹腔镜组(P<0.05)。机器人组术后3、6及12个月的国际勃起功能指数-15得分(男性患者)和女性性功能指数-19得分(女性患者)均高于腹腔镜组(P<0.05)。结论机器人手术治疗肥胖直肠癌患者是安全有效的,相比腹腔镜手术,其在保护术后泌尿生殖功能方面更能使患者获益。

Objective To compare and analyze the therapeutic effect of robotic and laparoscopic radical resection of rectal cancer for obese patients with rectal adenocarcinoma.Methods The retrospective cohort study was conducted.The clinicopathologic data of 217 obese patients with rectal adenocarcinoma who were treated in the First Affiliated Hospital of Zhengzhou University from October 2017 to January 2020 were collected,104 patients received radical resection of rectal cancer assisted by Da Vinci robotic surgical system and were assigned to the robot group,113 patients underwent laparoscopic-assisted radical resection of rectal cancer and were assigned to the laparoscope group.The perioperative indexes,pathological examination,and postoperative recovery of urogenital function were compared.Results There were no significant differences between the two groups in the gender,age,body mass index,distance from lower edge of tumor to anal edge,tumor diameter,American Association of Anesthesiologists classification,preoperative complications,preoperative carcinoembryonic antigen level,tumor differentiation,and TNM stage(P>0.05).The operations were successfully completed in all patients and there was no conversion to laparotomy and perioperative death.There were no significant differences between the two groups in the operation time,first exhaust time,first eating liquid food time,first getting out of bed activity time,drainage tube placement time,prophylactic stoma rate,and postoperative complications(P>0.05).The intraoperative blood loss and total hospital stay in the robot group were less than those of the laparoscope group(P<0.05).The International Prostate Symptom Score of the robot group was lower than that of the laparoscope group at 3,6,and 12 months after operation(P<0.05).The International Index of Erectile Function-15 score of male patients and Female Sexual Function Index-19 score of female patients in the robot group were higher than those in the laparoscope group at 3,6,and 12 months after operation(P<0.05).Conclusions Robotic surgery is safe and effective in treatment of obese patients with rectal adenocarcinoma.Compared with laparoscopic surgery,robotic surgery could benefit patients more in protecting postoperative genitourinary function.