机器人辅助手术与传统腹腔镜手术治疗ⅠB_(1)~ⅡA_(2)期宫颈癌的比较及术后并发症的影响因素分析

Comparison of robot-assisted Vs conventional laparoscopic radical hysterectomy for stageⅠB_(1)-ⅡA_(2)cervical cancer and analysis on influencing factors of postoperative complications

目的:比较达芬奇机器人手术系统与传统腹腔镜在ⅠB_(1)期~ⅡA_(2)期宫颈癌根治术的临床疗效,并分析影响术后并发症发生的相关危险因素。方法:回顾性分析2014年12月—2020年12月郑州大学第一附属医院妇科微创中心行机器人与传统腹腔镜手术治疗ⅠB_(1)期~ⅡA_(2)期宫颈癌患者的临床资料,根据手术方式不同分为机器人组和传统腹腔镜组,比较两组患者的临床指标及术后并发症的严重程度,并对影响宫颈癌根治术术后并发症发生的相关因素进行单因素(采用χ2检验和Fisher确切概率法)和多因素(采用Logistic回归法)分析。结果:本研究共纳入374例患者,其中机器人组172例,传统腹腔镜组202例,两组患者的一般临床资料无明显统计学差异。与传统腹腔镜组相比,机器人手术平均手术时间及平均术后住院时间较短。机器人组Clavien-DindoⅢ级并发症的发生率显著低于传统腹腔镜组。单因素分析结果提示年龄、BMI、合并内科疾病、手术方式是影响术后并发症发生的危险因素。多因素分析结果提示年龄、BMI、合并内科疾病是影响术后并发症发生的独立危险因素。结论:与传统腹腔镜手术相比,达芬奇机器人辅助腹腔镜手术治疗ⅠB_(1)期~ⅡA_(2)期宫颈癌的手术时间、术后住院时间短,严重并发症发生率低。年龄、BMI、合并内科疾病是影响宫颈癌术后并发症发生的独立危险因素。

Objective:To compare the clinical efficacy of Da Vinci robotic surgery and conventional laparoscopic surgery in treating stageⅠB_(1)-ⅡA_(2) cervical cancer,and to analyze the relevant risk factors that affect postoperative complications.Methods:The clinical data of patients with stageⅠB_(1)-ⅡA_(2) cervical cancer who underwent robotic and laparoscopic radical hysterectomy in the First Affiliated Hospital of Zhengzhou University from December 2014 to December 2020 were retrospectively analyzed.Results:A total of 374 patients were included in this study,including 172 cases in the robotic group and 202 cases in the conventional laparoscopic group.There was no significant difference in general clinical data between the two groups.The robotic group had the shorter average operative time and postoperative hospital stay than the conventional laparoscopic group.The incidence of Clavien-Dindo gradeⅢcomplications in the robotic group was significantly lower than that in the conventional laparoscopic group.Uunivariate analysis results indicated age,BMI,combined internal medicine diseases,and surgical methods were risk factors for postoperative complications.The results of multivariate analysis showed that age,BMI,and combined internal medicine diseases were independent risk factors for postoperative complications.Conclusion:Compared with conventional laparoscopic surgery,Da Vinci robot-assisted laparoscopic surgery in the treatment of stageⅠB_(1)-ⅡA_(2) cervical cancer has the less operative time,shorter length of hospital stay after surgery,and lower incidence of serious complications.Age,BMI,and combined internal medicine diseases are independent risk factors for postoperative complications of cervical cancer.