达芬奇机器人手术与腹腔镜手术治疗直肠癌的临床疗效对比(附550例报告)

Comparison of clinical efficacy between da Vinci■ robotic surgery and laparoscopic surgery for rectal cancer:a report of 550 cases

目的比较达芬奇机器人手术和腹腔镜手术治疗直肠癌的临床疗效。方法回顾性分析2015年1月至2020年6月在中国人民解放军北部战区总医院普通外科行直肠癌根治术的550例患者的临床资料,根据手术方式的不同,分为达芬奇机器人辅助直肠癌根治术组(机器人组,n=178)和腹腔镜直肠癌根治术组(腹腔镜组,n=372)。比较两组一般资料、围手术期指标,并进行生存分析。结果两组年龄、性别、BMI、ASA分级、新辅助放化疗情况、肿瘤距肛缘距离、TNM分期、肿瘤分化程度、合并黏液腺癌情况、手术类型、预防性造口情况、术后化疗情况等一般资料比较差异无统计学意义(P>0.05)。与腹腔镜组相比,机器人组手术时间更长、术中出血量更少,差异有统计学意义(P<0.05)。两组在是否中转开腹、排气时间、进食时间、创面疼痛程度(视觉模拟评分)、导尿管留置时间、住院时间、淋巴结清扫数目、肿瘤距标本下缘距离等方面比较差异无统计学意义(P>0.05)。两组均无肿瘤远切缘及环周切缘阳性患者。术后并发症方面,机器人组发生术后出血2例、吻合口漏4例、肠梗阻4例、排尿障碍2例;腹腔镜组发生术后出血4例、吻合口漏8例、肠梗阻9例、排尿障碍6例、盆腔脓肿1例,两组并发症总发生率比较差异无统计学意义(P>0.05)。随访截至2023年6月,随访时间为36~60个月,平均随访时间为(49.3±8.1)个月。两组1年、3年总生存率和无病生存率比较差异无统计学意义(P>0.05)。结论达芬奇机器人与腹腔镜手术治疗直肠癌相比,前者手术时间更长、出血量更少,在其他围手术期情况与远期生存方面比较差异无统计学意义,均安全、有效。

Objectives To compare the clinical efficacy of da Vinci®robotic surgery and laparoscopic surgery for rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 550 patients who underwent radical resection of rectal cancer in the Department of General Surgery,General Hospital of Northern Theater Command of People’s Liberation Army,from January 2015 to June 2020.Based on the surgical approach,patients were divided into two groups:da Vinci®robotic-assisted radical resection of rectal cancer(robotic group,n=178)and laparoscopic radical resection of rectal cancer(laparoscopic group,n=372).General information,perioperative indicators,and survival analysis were compared between the two groups.Results There were no statistically significant differences in age,gender,body mass index,American Society of Aneshesiologists(ASA)classification,neoadjuvant chemoradiotherapy,distance from tumor to the anal verge,tumor node metastasis stage,tumor differentiation,presence of mucinous adenocarcinoma,surgical type,preventive stoma,and postoperative chemotherapy between the two groups(P>0.05).Compared with the laparoscopic group,the robotic group had longer operative time but less intraoperative blood loss,with statistically significant differences(P<0.05).No significant differences were observed between the two groups in terms of conversion to open surgery,time to first flatus,time to resume oral intake,complications that including wound pain degree[visual analogue scale(VAS)],indwelling catheter duration,hospital stay,number of lymph nodes dissected,distance from tumor to the lower margin of the specimen(P>0.05).There were no patients with positive distal or circumferential resection margins in either group.Postoperative complications included 2 cases of postoperative bleeding,4 anastomotic leaks,4 intestinal obstructions,and 2 urination disorders in the robotic group;while the laparoscopic group had 4 cases of postoperative bleeding,8 anastomotic leaks,9 intestinal obstructions,6 urination disorders,and 1 pelvic abscess.There was no statistically significant difference in the overall incidence of complications between the two groups(P>0.05).The follow-up period ended in June 2023 ranged from 36 to 60 months,with an average follow-up time of(49.3±8.1)months.No significant differences were found in 1-year and 3-year overall survival rates and disease-free survival rates between the two groups(P>0.05).Conclusion Compared with laparoscopic surgery for rectal cancer,the da Vinci®robotic system is associated with longer operative time but less blood loss.There are no significant differences in other perioperative outcomes and long-term survival,indicating that both methods are safe and effective.