达芬奇机器人手术系统辅助与腹腔镜辅助近端胃癌根治性全胃切除+保脾脾门淋巴结清扫的短期疗效研究

Short-term efficacy of Da Vinci robot versus laparoscopic-assisted radical total gastrectomy for proximal gastric cancer with spleen-preserving splenic hilar lymph node dissection

目的探讨达芬奇机器人手术系统辅助对近端胃癌根治性全胃切除+保脾脾门淋巴结清扫的安全性、可行性及短期临床疗效,以明确达芬奇机器人手术系统相较于传统腹腔镜在保脾脾门淋巴结清扫上是否具有优势。方法回顾性分析2017年1月—2020年12月中国人民解放军联勤保障部队第九四〇医院119例行根治性全胃切除+保脾脾门淋巴结清扫的近端胃癌患者的临床资料。其中,62例行达芬奇机器人手术系统根治性全胃切除+保脾脾门淋巴结清扫(机器人组),57例行腹腔镜根治性全胃切除+保脾脾门淋巴结清扫(腹腔镜组)。比较两组患者一般资料、术中情况、术后及并发症情况。结果两组患者年龄、性别构成、BMI、TNM分期、肿瘤直径、pT分期、pN分期、分化程度、病理类型、肿瘤部位等一般资料比较,差异无统计学意义(P>0.05)。机器人组术中出血量少于腹腔镜组(P<0.05),淋巴结清扫总数和第一站淋巴结数目多于腹腔镜组(P<0.05),术后首次排气时间早于腹腔镜组(P<0.05);两组第二站淋巴结数目、脾门淋巴结总数、脾门淋巴结阳性率、手术时间、引流管拔管时间、术后住院时间及术后并发症比较,差异无统计学意义(P>0.05)。结论达芬奇机器人手术系统辅助对近端胃癌患者行根治性全胃切除+保脾脾门淋巴结清扫是安全可行的,机器人组在淋巴结清扫总数、控制术中出血及肠道恢复上可能更具一定的优势。

Objective To investigate the safety,feasibility,and short-term clinical efficacy of Da Vinci robotassisted radical total gastrectomy for proximal gastric cancer with spleen-preserving splenic hilar lymph node dissection,in order to clarify whether the Da Vinci robot has advantages over conventional laparoscopy for spleenpreserving splenic hilar lymph node dissection.Methods Retrospective analysis and selection of 119 patients with proximal gastric cancer who underwent radical total gastrectomy with spleen-preserving splenic hilar lymph node dissection from January 2017 to December 2020,of which 62 cases underwent Da Vinci robot radical total gastrectomy and 57 cases underwent laparoscopic radical total gastrectomy.The general information,intraoperative postoperative,and complication conditions were compared between the two group.Results There was no statistically significant difference between the two groups in the comparison of general data of age,gender composition,BMI,TNM stage,tumor diameter,p T stage,pN stage,degree of differentiation,pathological type and tumor site(P>0.05).The robotic group had less intraoperative bleeding than the laparoscopic group(P<0.05),more total lymph node dissection than the laparoscopic group(P<0.05),more lymph nodes at the first station than the laparoscopic group(P<0.05),and the first postoperative venting was earlier than the laparoscopic group(P<0.05);the number of lymph nodes in the second station,the number of lymph nodes in the splenic portal,the positive rate of splenic portal lymph nodes,operative time,drainage tube extraction time,postoperative hospital stay,and postoperative complications were not statistically significant differences(P>0.05).Conclusion Da Vinci robotassisted radical total gastrectomy for proximal gastric cancer with spleen-preserving splenic hilar lymph node dissection is safe and feasible,and the robotic group may have certain advantages in total lymph node dissection,control of intraoperative bleeding,and bowel recovery.