机器人辅助手术在复杂大子宫中的应用及疗效分析(附手术视频)

Clinical efficacy of robot-assisted surgery in complex enlarged uterus(with surgical video)

目的:通过对比机器人辅助手术、传统腹腔镜手术及开腹手术3种不同术式在复杂大子宫切除术中的临床应用疗效,为临床医生选择术式提供参考。方法:收集2021年1月—2023年10月在青岛大学附属医院因子宫腺肌病或子宫肌瘤、子宫体≥孕12周、行全子宫切除术、术后病理证实为良性肿瘤的143名患者资料。根据手术方式不同,将患者分为机器人组45例、腹腔镜组60例、开腹组38例。比较三组患者一般资料及围手术期相关指标。结果:机器人组与开腹组子宫大小及体积均大于腹腔镜组;机器人组术中操作出血量与腹腔镜组相比差异无统计学意义,但均少于开腹组,总失血量与开腹组相比差异无统计学意义,但均多于腹腔镜组;机器人组相对手术时间长于腹腔镜组及开腹组,但绝对手术时间与腹腔镜组及开腹组相比差异均无统计学意义;机器人组术后排气时间均短于腹腔镜组及开腹组,术后住院时间与腹腔镜组相比差异无统计学意义,但均少于开腹组;机器人组住院总花费均高于腹腔镜组及开腹组。三组间手术并发症相比差异无统计学意义。结论:达芬奇机器人辅助手术兼具腹腔镜及开腹手术的优势,可以完成体积更大的复杂大子宫手术,而绝对手术时间、术中出血量及并发症发生率等并未增加,且术后恢复快,住院时间短,虽花费较高,但在合理选择患者的情况下更有利于患者恢复。

Objective:To compare the clinical efficacy of robot-assisted surgery,conventional laparoscopic surgery and open surgery for complex enlarged uterus.Methods:Clinical data of 143 patients with adenomyosis or uterine fibroids who were treated in the Affiliated Hospital of Qingdao University from January 2021 to October 2023 were collected.All the patients had the size of uterus body≥12 weeks of pregnancy and received total hysterectomy,and postoperative pathology confirmed as benign tumors.According to different surgical methods,the patients were divided into the robotic group(n=45),laparoscopic group(n=60)and laparotomy group(n=38).The general data and related perioperative indexes were compared among the three groups.Results:The size and volume of uterus in the robotic group and the open group were larger than those in the laparoscopic group.Intraoperative bleeding in the robotic group was not statistically different with that in the laparoscopic group,but was less than that in the open group.Total blood loss of the robotic group was not statistically different with that in the open group,but was more than that in the laparoscopic group.Compared with the laparoscopic group and the open group,the relative operative time in the robotic group was longer,but the difference in absolute operative time of the two groups was not statistically significant.The postoperative time to exhaustion was shorter in the robotic group than that in the laparoscopic group and the open group.The difference in postoperative hospitalization time between the robotic group and the laparoscopic group was not statistically significant,but it was less in the robotic group than that in the open group.The total cost of hospitalization was higher in the robotic group than that in the laparoscopic and open groups.Conclusion:Da Vinci robot-assisted surgery has the advantages of both laparoscopic and open surgery,which can be used to perform complex enlarged uterus surgery even in larger size without increasing the absolute operative time,intraoperative bleeding and complications.With quick recovery and short length of hospital stay,although the hospitalization cost of Da Vinci robot-assisted surgery is higher,it is more conducive to the recovery of patients in the case of reasonable selection of patients.