基于倾向评分匹配的机器人辅助与胸腹腔镜微创三切口食管癌根治术近期疗效比较

Comparison of the Recent Efficacy of Robot-assisted and Thoracic Laparoscopic Minimally Invasive Mckeown Radical Resection of Esophageal Cancer based on Propensity Score Matching

【目的】探讨机器人辅助微创食管癌切除术(RAMIE)和胸腹腔镜联合微创食管癌切除术(MIE)的安全性与有效性。【方法】回顾性分析中国科学技术大学第一附属医院胸外科2021年4月至2022年12月收治的188例接受微创Mckeown食管癌切除术的患者资料。其中RAMIE组69例,男性49例,女性20例,年龄(67.2±7.2)岁;MIE组119例,男性89例,女性30例,年龄(69.1±7.0)岁。采用倾向性评分匹配法(PSM)对两组患者进行1∶1匹配,匹配后RAMIE组58例,MIE组58例。采用t检验、Pearsonχ^(2)检验、Fisher’s精确检验等比较两组患者术中情况和术后并发症发生率。【结果】经过PSM处理后,两组患者基线资料无明显差异。RAMIE组和MIE组在手术时间、术后带管天数、淋巴结清扫总数方面无明显差异(P<0.05);在术中出血、左喉返淋巴结清扫数目方面RAMIE组优于MIE组,差异有统计学意义(P<0.05);MIE组在淋巴结清扫总站数方面更优(P<0.05)。在术后并发症方面RAMIE组和MIE组两组数据差异无统计学意义(P>0.05)【结论】RAMIE近期疗效与MIE食管癌切除术相当;机器人辅助微创食管癌切除术可以减少术中出血同时在淋巴结清扫中尤其是在喉返神经旁淋巴结清扫中更具优势。

【Objective】To explore the safety and efficacy of robot-assisted minimally invasive esophagectomy(robotassisted minimally invasive esophagectomy,RAMIE)and thoracic laparoscopy combined with minimally invasive esopha⁃geal resection(minimal invasive esophagectomy,MIE)【.Methods】The data of 188 patients treated with Da Vinci robot assisted minimally invasive esophageal resection(RAMIE)from April 2021 to December 2022 were analyzed.In the RAMIE group,69 patients,49 males and 20 female,age(67.2±7.2);119 in the MIME group,respectively,89 males and 30 fe⁃male,age(69.1±7.0).At 1∶1,including 58 patients in the RAMIE group and 58 patients in the MIE group.The t-test,Wilcoxon rank-sum test,χ^(2) test,and so on.【Results】After PSM treatment,the clinical data between the two groups.There was no significant difference in operation time,postoperative tube days,and total number of lymph node dissection between the RAMIE and MIE groups(P<0.05);the RAMIE group was better in terms of intraoperative bleeding and the MIE group,statistically significant(P<0.05);the MIE group was better in drainage flow and lymph node dissection for three days(P<0.05).In terms of postoperative complications,there was no statistical difference between RAMIE and MIE groups(P>0.05)【.Conclusion】The recent efficacy of robot-assisted minimally invasive esophagectomy is comparable to that of thoracic laparoscopy and minimally invasive Mckeown esophagectomy;robotic-assisted minimally invasive esophagecto⁃my can reduce intraoperative bleeding and have more advantages in left recurrent laryngeal nerve lymph node dissection.