完全机器人手术系统和机器人手术系统辅助胃癌根治术的近期疗效分析

The short‐term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer

目的:探讨完全机器人手术系统和机器人手术系统辅助胃癌根治术的近期疗效。方法:采用回顾性队列研究方法。收集2018年1月至2021年11月陆军军医大学第一附属医院收治的290例行机器人手术系统胃癌根治术患者的临床病理资料;男208例,女82例;年龄为58(24~84)岁。290例患者中,125例行完全机器人手术系统胃癌根治性切除+消化道重建术,设为完全机器人组;165例行腹上区小切口辅助机器人手术系统胃癌根治性切除+消化道重建术,设为机器人辅助组。观察指标:(1)手术及术后情况。(2)术后并发症情况。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。等级资料比较采用非参数秩和检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果:(1)手术及术后情况。完全机器人组和机器人辅助组患者手术时间、术中出血量、切口长度、术后镇痛剂使用时间、术后胃管拔除时间、术后首次饮水时间、术后首次肛门排气时间、术后住院时间分别为(246±43)min、(104±51)mL、4(3~6)cm、(2.2±0.5)d、36(10~112)h、62(32~205)h、63(18~138)h、8(6~50)d和(296±59)min、(143±87)mL、6(3~13)cm、(3.6±0.7)d、42(12~262)h、90(18~262)h、80(16~295)h、9(6~63)d,两组患者上述指标比较,差异均有统计学意义(t=8.04、4.42,Z=-13.98,t=18.46,Z=-5.47、-5.87、-6.14、-4.04,P<0.05)。(2)术后并发症情况。完全机器人组和机器人辅助组患者全身相关总并发症、肺部感染分别为7、4例和31、16例,两组比较,差异均有统计学意义(χ^(2)=10.86,4.68,P<0.05)。进一步分析结果显示:两组术后发生并发症患者年龄≥60岁、体质量指数≥25 kg/m 2、肿瘤长径≥3 cm、TNM分期为Ⅲ期比较,差异均有统计学意义(风险比=0.44,0.17,0.40,0.31,95%可信区间为0.20~1.00,0.03~0.88,0.18~0.89,0.11~0.84,P<0.05)。结论:完全机器人手术系统胃癌根治术安全、可行,创伤更小、恢复更快,尤其对年龄≥60岁、体质量指数≥25 kg/m 2、肿瘤长径≥3 cm及TNM分期为Ⅲ期患者的并发症控制更有优势。

Objective To investigate the short-term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 290 patients who underwent robotic surgical system radical gastrectomy for gastric cancer in the First Affiliated Hospital of Army Medical University from January 2018 to November 2021 were collected.There were 208 males and 82 females,aged 58(range,24‒84)years.Of the 290 patients,125 patients undergoing totally robotic surgical system radical gastrectomy combined with reconstruction of digestive tract were divided into the totally robot group,and 165 patients undergoing robotic surgical system radical gastrectomy combined with a small midline incision-assisted reconstruction of digestive tract were divided into the robotic-assisted group.Observation indicators:(1)surgical and postoperative situations;(2)postoperative complications.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Comparison of ordinal data was conducted using the non-parameter rank sum test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Results(1)Surgical and postoperative situations.The operation time,volume of intraoperative blood loss,length of incision,duration of postoperative analgesic using,time to postoperative gastric tube removal,time to postoperative initial water intake,time to postoperative first anal flatus,duration of postoperative hospital stay were(246±43)minutes,(104±51)mL,4(range,3‒6)cm,(2.2±0.5)days,36(range,10‒112)hours,62(range,32‒205)hours,63(range,18‒138)hours,8(range,6‒50)days in patients of the totally robot group,versus(296±59)minutes,(143±87)mL,6(range,3‒13)cm,(3.6±0.7)days,42(range,12‒262)hours,90(range,18‒262)hours,80(range,16‒295)hours,9(range,6‒63)days in patients of the robotic-assisted group,showing significant differences in the above indicators between the two groups(t=8.04,4.42,Z=‒13.98,t=18.46,Z=‒5.47,‒5.87,‒6.14,‒4.04,P<0.05).(2)Postoperative complications.Cases with systemic related complications and cases with pulmonary infection were 7 and 4 in patients of the totally robot group,versus 31 and 16 in patients of the roboticassisted group,showing significant differences in the above indicators between the two groups(χ²=10.86,4.68,P<0.05).Further analysis showed that there were significant differences in age≥60 years,body mass index≥25 kg/m2,tumor diameter≥3 cm,TNM staging as stageⅢof cases with postoperative complications between the totally robot group and the robotic-assisted group(odds ratio=0.44,0.17,0.40,0.31,95 confidence interval as 0.20‒1.00,0.03‒0.88,0.18‒0.89,0.11‒0.84,P<0.05).Conclusion Totally robotic surgical system radical gastrectomy for gastric cancer is safe and feasible with advantages of minimal trauma and quick recovery,especially for patients as age≥60 years,body mass index≥25 kg/cm2,tumor diameter≥3 cm and TNM stageⅢin complication controlling.