达芬奇机器人辅助全结肠切除术的临床效果观察

Clinical efficacy observation of da Vinci■ robot-assisted total colectomy

目的观察达芬奇机器人辅助全结肠切除术的临床应用效果。方法回顾性分析2017年12月至2024年2月期间就诊于中国人民解放军联勤保障部队第九四〇医院结直肠肛门外科并行全结肠切除术的32例患者(结肠慢传输型便秘、家族性腺瘤性息肉病、多原发性结肠癌)的临床资料,按手术平台进行分组,其中机器人组(行机器人辅助全结肠切除术)12例,腹腔镜组(行腹腔镜辅助全结肠切除术)20例。比较两组一般情况(性别、年龄、BMI、合并基础疾病、术前诊断、术前白蛋白、术前血红蛋白)、术中情况(手术时间、术中出血量、是否中转开腹等)和术后情况(术后首次经口进食时间、术后首次排气时间、总住院时间、总住院费用、术后并发症等)。结果两组性别、年龄、BMI、合并基础疾病、术前白蛋白、术前血红蛋白比较差异无统计学意义(P>0.05),两组术前诊断患者比例比较差异有统计学意义(P<0.05)。两组中转开腹患者比例、手术时间、术中出血量、术后首次经口进食时间、术后首次排气时间、总住院时间、术后并发症比较差异无统计学意义(P>0.05);机器人组的总住院费用多于腹腔镜组(P<0.05)。结论与腹腔镜辅助全结肠切除术相比,机器人辅助全结肠切除术并未增加术中出血量、中转开腹患者比例和延长术后首次经口进食时间、术后首次排气时间、总住院时间,提示机器人辅助全结肠切除术安全、可行。

Objectives To observe the clinical efficacy of da Vinci®robot-assisted total colectomy.Methods A retrospective analysis was conducted on the clinical data of 32 patients(slow transit constipation,familial adenomatous polyposis,and multiple primary colon cancers)who underwent total colectomy in the department of colorectal&anal surgery,The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from December 2017 to February 2024.The patients were grouped according to the surgical platform,with 12 cases in the robotic group(undergoing robot-assisted total colectomy)and 20 cases in the laparoscopic group(undergoing laparoscopic-assisted total colectomy).The general conditions(sex,age,BMI,combined underlying diseases,preoperative diagnosis,preoperative albumin,preoperative hemoglobin),intraoperative conditions(operation time,intraoperative blood loss,conversion to open surgery,etc.)and postoperative conditions(time of first oral intake,time of first postoperative exhaust,total hospital stay,total hospitalization cost,and postoperative complications)were compared between the two groups.Results There was no significant difference between the two groups in sex,age,BMI,combined underlying diseases,preoperative albumin and preoperative hemoglobin(P>0.05),but there was significant difference in the proportion of preoperative diagnosis between the two groups(P<0.05).There were no statistically significant differences in the proportion of patients converted to open surgery,operation time,intraoperative blood loss,time of first oral intake,time of first postoperative exhaust,total hospital stay,and postoperative complications between the two groups(P>0.05).The total hospitalization cost in the robotic group was higher than that in the laparoscopic group(P<0.05).Conclusion Compared with laparoscopic-assisted total colectomy,robot-assisted total colectomy did not increase intraoperative blood loss,the proportion of patients converted to open surgery,or prolong the time of first oral intake,time of first postoperative exhaust,and total hospital stay,suggesting that robot-assisted total colectomy is safe and feasible.