机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较

Comparison of long-term therapeutic effects in patients with middle and low rectal cancer using robot-assisted laparoscopy combined with natural orifice specimen extraction

目的探讨机器人辅助手术与腹腔镜辅助手术联合经自然腔道取标本(NOSES),治疗中低位直肠癌患者的长期治疗效果差异。方法对联勤保障部队第九四〇医院2018年6月至2021年6月期间收治的64例经NOSES治疗中低位直肠癌患者进行回顾性分析,其中20例采用机器人辅助(R-N组),44例采用腹腔镜辅助(L-N组)。术后通过电话或者门诊进行随访,随访时间截至2022年9月。对两组患者的基本资料、术中情况、术后并发症以及3年无病生存期(DFS)和总生存期(OS)等进行对比。结果与L-N组相比,R-N组的住院费用显著增加,手术时间更长(P<0.001),术中出血量相对减少(P=0.001);在术后首次排气时间上,R-N组较L-N组明显缩短(P=0.016);此外,R-N组术后使用镇痛药物(含帕瑞昔布钠)的次数少于L-N组(P=0.002);两组术后并发症发生率和标本病理结果差异无统计学意义。两组3年DFS和OS比较,差异无统计学意义(DFS:80.0%vs 86.4%,P=0.892;OS:90.0%vs 90.9%,P=0.707)。结论与腹腔镜辅助中低位直肠癌手术联合NOSES相比,机器人辅助中低位直肠癌手术联合NOSES具有较高的安全性和有效性,且术中出血量和术后并发症较少,可以改善患者的预后。

Objective To compare the long-term treatment outcomes of robotic-assisted natural orifice specimen extraction surgery(NOSES)with laparoscopic-assisted surgery in patients with mild-to-low risk rectal cancer.Methods A retrospective analysis was conducted in 64 patients with middle to low rectal cancer who underwent NOSES treatment in the 940th Hospital of the Joint Logistic Support Force between June 2018 and June 2021.20 cases(R-N group)received robotic assistance surgery,while 44 cases(L-N group)underwent laparoscopic-assisted surgery.The follow-up period extended until September 2022 and was conducted via phone or outpatient visits.The study compared basic demographics,intraoperative conditions,postoperative complications,and three-year disease-free survival(DFS)and overall survival(OS)between the two groups.Results The R-N group had significantly higher hospitalization costs and longer operation time compared to the L-N group(P<0.001).However,intraoperative blood loss was significantly less in the R-N group(P=0.001).Additionally,the R-N group experienced shorter first postoperative flatus time(P=0.016)and lower usage of postoperative analgesics,including parecoxib sodium(P=0.002).There were no significant differences in postoperative complications and pathological outcomes between the two groups.The three-year OS(90.0%vs 90.9%,P=0.707)and DFS(80.0%vs 86.4%,P=0.892)were similar between both groups.Conclusion Compared to laparoscopic-assisted surgery combined with NOSES for middle to low rectal cancer,robotic-assisted surgery combined with NOSES offers higher safety and efficacy,reduced intraoperative blood loss,fewer postoperative complications,and potentially better patient prognosis.