机器人与普通腹腔镜辅助结直肠癌D3根治术短期临床疗效比较

Comparison of short-term clinical efficacy between robotic and conventional laparoscopy-assisted D3 radical resection for colorectal cancer

目的 比较使用机器人与普通腹腔镜辅助结直肠癌D3根治术的短期临床疗效,探讨机器人辅助手术在结直肠外科中的潜在优势。方法 收集2016年9月至2019年12月于四川省人民医院胃肠外科施行机器人腹腔镜根治性手术的单原发性结直肠癌患者153例(机器人组),按1∶1比例匹配普通腹腔镜组,匹配变量包括患者年龄、手术方式、是否行新辅助治疗。比较两组患者术中情况、术后恢复情况、术后并发症及住院时间与费用等。对术后住院时间>7天的患者进行Logistic危险因素分析。结果 机器人组术中出血量较腹腔镜组少,手术时间较腹腔镜组长,术后排气时间、术后进流质时间、术后引流管拔除时间及术后住院时间均较腹腔镜组短(P<0.05);机器人组术后总体并发症发生率低于腹腔镜组(P<0.05),总费用高于腹腔镜组(P<0.05)。多因素Logistic回归分析显示ASA分级III级、任意并发症、普通腹腔镜手术是术后住院时间>7天的危险因素(P<0.05)。结论 与普通腹腔镜手术相比,机器人手术具有更好的短期临床疗效。

Objective To compare the short-term clinical outcomes of D3 radical surgery for colorectal cancer between robotic and conventional laparoscopy,and explore the potential advantages of robotic assisted surgery in colorectal surgery.Methods One hundred and fifty-three patients with single primary colorectal cancer undergoing robotic laparoscopic radical surgery at our department from September 2016 to December 2019 were collected(robotic group).Patients undergoing conventional laparoscopy surgery at the same period were matched to the robotic group at a ratio of 1∶1(conventional laparoscopy group).The matching variables included age,surgical approach,and whether to perform neo-adjuvant therapy.The intraoperative conditions,postoperative recovery,postoperative complications,and length and cost of postoperative hospital stay were compared between the two groups.Logistic risk factor analysis was performed for patients with postoperative hospital stay>7 days.Results The intraoperative blood loss in the robotic group was less than that in the conventional laparoscopic group.The operative time in the robotic group was longer than that in the conventional laparoscopic group.The postoperative flatus time,postoperative fluid intake time,postoperative drain removal time and postoperative hospital stay in the robotic group were shorter than those in the conventional laparoscopic group.All differences were statistically significant(P<0.05).The total incidence of complications in the robotic group was lower than that in the conventional laparoscopic group.However,total costs of the robotic group were higher than that of the conventional laparoscopic group(P<0.05).Multivariate Logistic regression analysis showed that ASA grade III,any complications,and conventional laparoscopic surgery were risk factors for postoperative hospital stay>7 days(P<0.05).Conclusions Compared to conventional laparoscopic surgery,robotic surgery has better short-term clinical outcomes.