达芬奇机器人辅助食管裂孔疝修补术的疗效研究

Da-vinci robot-assisted surgery vs laparoscopic repair for the treatment of hiatal hernia repair

目的探讨达芬奇机器人手术系统对比腹腔镜手术用于食管裂孔疝修补术的疗效及安全性。方法回顾性分析2019年12月至2022年5月于徐州医科大学附属医院疝与腹壁外科行食管裂孔疝修补联合Nissen胃底折叠术患者的临床资料,共计115例,其中48例行达芬奇机器人手术为达芬奇机器人组(robot-assisted surgery,RS组);67例行腹腔镜手术为腹腔镜组(laparoscopic surgery,LS组)。统计其围手术期资料及术后主要并发症情况,以胃食管反流病自测量表(GERD Questionnaire,GERD-Q)为标准评价患者术前与术后症状改善情况。采用倾向性评分匹配(propensity score matching,PSM),按1∶1比例匹配,卡钳值设置为0.2。比较匹配后两组患者的临床资料。结果经PSM后,两组各纳入46例患者,与LS组相比,RS组术中出血量更少(P<0.001),术后胃肠道功能恢复更快(P<0.001),术后住院时间更短(P=0.002)。LS组手术时间短(P<0.001),住院总费用更低(P<0.001)。两组患者术后3个月及6个月GERD-Q评分较术前明显下降(均P<0.001)。两组部分患者在术后出现吞咽困难或慢性腹泻的症状,但在术后并发症发生率上差异无统计学意义(P>0.05)。术后随访两组患者均未见复发。结论达芬奇机器人辅助食管裂孔疝修补术同腹腔镜下食管裂孔疝修补术都是安全可行的手术方式。机器人手术创伤更小,术后恢复更快。

Objective To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery,the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied.After propensity score matching(PSM),46 cases in each group were included:Robot-assisted surgery(RS group)and laparoscopic surgery(LS group).Postoperative complications were collected and GERD Questionnaire(GERDQ)were used as the standard in evaluation of the results.Results Patients in RS group had less intraoperative bleeding(P<0.001),shorter postoperative gastrointestinal recovery time(P<0.001),and shorter postoperative hospital stay(P=0.002).The LS group had a shorter operative time(P<0.001)and lower total hospital cost(P<0.001).GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores(P<0.001).There was no statistically significant difference between the two groups in the incidence of postoperative complications(P>0.05).No recurrence was seen in both groups during postoperative follow-up.Conclusion Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures,with less intraoperative trauma and quicker,earlier recovery.