机器人辅助腹腔镜与传统腹腔镜手术治疗妊娠期附件包块的临床对比研究

Comparative study of robot-assisted and conventional laparoscopic surgery in the treatment of adnexal masses in pregnancy

目的:对比并评估达芬奇机器人手术与传统腹腔镜手术治疗妊娠期附件包块的效果,分析达芬奇机器人手术治疗妊娠期附件包块的安全性及可行性。方法:收集2019年1月—2023年1月郑州大学第一附属医院妇科收治的57例妊娠期附件包块患者的临床资料,按手术方式不同分为机器人组(n=17)和传统腹腔镜组(n=40)。比较两组患者的一般情况资料、围手术期资料、妊娠结局、终止妊娠方式及新生儿结局。结果:两组患者的年龄、体质指数、既往腹部手术史发生率、产次、糖类抗原125、附件包块侧性、附件包块性质、术后并发症发生率、附件包块病理类型相比,差异均无统计学意义(P>0.05)。与传统腹腔镜组相比,机器人组患者孕周更长,附件包块直径更大,急诊手术率更低,手术时间更短,术中估计失血量更少,术后排气时间更短,术后住院时间更短,住院总费用更多。两组患者术中均未发生并发症、输血或中转开腹。两组患者的妊娠结局、终止妊娠方式、新生儿出生孕周、新生儿出生体重、新生儿1 min Apgar评分、新生儿5 min Apgar评分及新生儿并发症发生率相比,差异均无统计学意义(P>0.05)。结论:达芬奇机器人手术治疗妊娠期附件包块是安全、有效、可行的。妊娠期附件包块患者接受达芬奇机器人手术与传统腹腔镜手术术后的妊娠结局、终止妊娠方式和新生儿结局相似。与传统腹腔镜手术相比,即使在更大的妊娠期子宫和(或)更大的附件包块而导致手术难度较高的情况下,达芬奇机器人手术仍能表现出手术时间更短、术中出血量更少、术后肠道功能恢复更快、术后住院时间更短等优势。

Objective:To evaluate the treatment effects of Da Vinci robotic surgical system in the treatment of adnexal masses in pregnancy by comparing with conventional laparoscopic surgery,and to analyze its safety and feasibility.Methods:The clinical data of 57 patients with adnexal masses in pregnancy who were admitted to the Department of Gynecology of the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2023 were collected,including 17 cases in the robotic group and 40 cases in the conventional laparoscopic group.The general information,preoperative data,pregnancy outcome,ways to end pregnancy of patients and neonatal outcome in the two groups were compared and analyzed.Results:There was no statistically significant difference in age,body mass index(BMI),incidence of previous abdominal surgery history,gravidity,carbohydrate antigen 125,laterality of adnexal masses,nature of adnexal masses,incidence of postoperative complications,and pathological type of adnexal masses between the two groups(P>0.05).Compared with the conventional laparoscopic group,patients in the robotic group had longer gestational period,larger adnexal mass diameter,lower rate of emergency surgery,shorter operative time,less estimated intraoperative blood loss,shorter postoperative time to exhaustion,shorter postoperative hospital stay,and higher hospital costs.No intraoperative complications,blood transfusions or intermediate conversion to laparotomy occurred in the two groups.There was no statistically significant difference in pregnancy outcome,ways to end pregnancy,gestational weeks,baby weight at birth,1-minute Apgar score of newborn,5-minute Apgar score of newborn and incidence of neonatal comorbidities between the two groups(P>0.05).Conclusion:The Da Vinci robotic surgical system is feasible,safe and effective in the treatment of adnexal masses in pregnancy.Pregnancy outcomes,ways to end pregnancy and neonatal outcomes of patients with adnexal masses in pregnancy under robot-assisted surgery are similar with the conventional laparoscopic surgery.Compared to the conventional laparoscopic surgery,Da Vinci Robotic Surgical System offers the advantages of shorter operative times,less intraoperative bleeding,faster recovery of bowel function and shorter postoperative hospital stays in treating patients with adnexal masses during pregnancy,even in cases of more difficult surgeries caused by a larger gestational uterus and/or adnexal masses.