机器人与腹腔镜辅助下肝切除手术对肝癌患者术后康复的效果对比

Comparison of postoperative rehabilitation effects between robot-assisted and laparoscopic hepatectomy for liver cancer

目的:分析机器人辅助肝切除术与腹腔镜肝切除术对肝癌患者的术后康复效果。方法:回顾2020年1月—2023年10月中国人民解放军联勤保障部队第九八○医院收治的165例肝癌患者的手术资料。按不同手术方案分为两组,腹腔镜组96例实施腹腔镜下肝切除手术,机器人组69例实施机器人辅助下肝切除手术。对比两组患者围术期指标、中转开腹率及并发症发生情况。结果:与腹腔镜组相比,机器人组手术时间更长,术中各种精细操作时间明显缩短,术中肝门阻断率更高。两组术中操作失血量、术后住院时间、总住院时间、术中输血率及中转开腹率比较无差异。术后1 d、3 d时机器人组天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素含量略微低于腹腔镜组,白蛋白高于腹腔镜组。两组术后并发症发生情况比较无差异。结论:与腹腔镜肝切除术相比,机器人辅助肝切除术可缩短肝癌患者术中各种精细操作时间,增加术中肝门阻断率,且对中转开腹、并发症发生风险无增加情况,值得临床继续探讨应用。

Objective:To analyze the postoperative rehabilitation effects of robot-assisted and laparoscopic hepatectomy on liver cancer patients.Methods:The surgical data of 165 liver cancer patients who underwent robot-assisted and laparoscopic hepatectomy in the 980th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from January 2020 to October 2023 was retrospectively analyzed.The 165 patients were divided into two groups according to different surgical methods.96 cases of laparoscopic hepatectomy were divided into the laparoscopic group,and 69 cases of robot-assisted hepatectomy into the robotic group.The perioperative surgical indicators,conversion rate to open surgery,and complications between the two groups of patients were compared.Results:The operative time of the robotic group was longer than that of the laparoscopic group,while there was no difference in intraoperative blood loss,postoperative hospital stay,and total hospital stay between the two groups.The intraoperative hepatic portal occlusion rate in the robotic group was higher than that in the laparoscopic group.There was no difference in intraoperative blood transfusion rate and conversion rate between the two groups.The time for fine manipulations in the robotic group was significantly shorter than that in the laparoscopic group.Aspartate aminotransferase,alanine aminotransferase and total bilirubin in the robotic group at 1 d and 3 d after surgery was slightly lower than those in the laparoscopic group,while albumin level in the laparoscopic group was higher than that in the robotic group.There was no difference in the incidence of postoperative complications between the two groups.Conclusion:Compared with laparoscopic hepatectomy,robot-assisted hepatectomy can shorten the time for fine operation,increase intraoperative hepatic portal occlusion rate,but increase no risk of conversion to open surgery or complications,which is worth further exploration and application in clinical practice.