目的：研究免举宫技术用于机器人辅助宫颈癌根治术的临床效果，并分析术后复发的相关因素。 方法：收集 2017 年 2 月—2022 年 2 月空军军医大学第二附属医院收治的 248 例行机器人辅助宫颈癌根治术的患者 作为研究对象，根据手术方式的不同将患者分为两组。观察组行宫底悬吊免举宫机器人辅助宫颈癌根治术，对照组 在宫腔内放置举宫器举宫后行机器人辅助宫颈癌根治术。回顾性分析两组手术治疗情况、手术后并发症发生率，对 比其术后复发率，并采用多因素 Logistic 回归模型分析手术后复发相关因素。结果：两组患者术中出血量、引流量、 手术时间及肿瘤病理分型比较，差异均无统计学意义（P>0.05）。观察组住院时间较对照组显著缩短，术后无复发 生存率低于对照组，差异均有统计学意义（P<0.05）。两组术后首次排气时间和术后并发症发生率比较，差异无统 计学意义（P>0.05）。多因素 Logistic 回归模型分析显示，宫颈深度浸润和盆腔淋巴结转移是术后复发的高危因素， 采用免举宫技术是术后复发的保护因素。结论：免举宫技术用于机器人辅助宫颈癌根治术疗效显著，有助于降低术 后复发率；宫颈深度浸润和盆腔淋巴结转移将显著增加复发风险。

Objective: To study the clinical effect of robot-assisted radical hysterectomy without using uterine manipulator for cervical cancer and analyze the influencing factors of postoperative recurrence. Methods: 248 patients with cervical cancer who underwent robot-assisted hysterectomy in our hospital from February 2017 to February 2022 were selected as research objects. All selected patients were divided into the observation group and the control group according to different surgical methods. The observation group was treated with robot-assisted radical hysterectomy by suspending the uterus without using uterine manipulator, while the control group was assisted with uterine manipulator during the operation. The surgical treatment and postoperative complication rate of the two groups were analyzed retrospectively, the postoperative recurrence rate was compared and the related factors influencing postoperative recurrence were analyzed with multivariable logistic regression model. Results: There were no significant difference between the two groups in the amount of bleeding, drainage volume, operative time and tumor pathological classification (P>0.05). The length of hospital stay in the observation group was significantly shorter than that in the control group, and the RFS (Relapse-free Survival) rate of the observation group was lower than that in the control group, the differences were statistically significant (P<0.05). There was no significant difference between the two groups in the time of first exhaust and the incidence of postoperative complications (P>0.05). The multivariable logistic regression model analysis result showed that the deep invasion of cervical stroma and pelvic lymph node metastasis were high risk factors for postoperative recurrence, the surgical skill of suspending the uterus without the use of uterine manipulator (P<0.001) was a protective factor for postoperative recurrence. Conclusion: The application of robot-assisted radical hysterectomy without using uterine manipulator for cervical cancer has a significant clinical effect, which could reduce the recurrence rate after surgery. The deep invasion of cervical stroma and pelvic lymph node metastasis could significantly increase the risk of recurrence. Key words  Radical Hysterectomy; Robot-assisted Surgery; Uterine Manipulator; Technology without Uterine Manipulator; Postoperative Complication; Recurrence

收稿日期：2023-01-05  录用日期：2023-06-10 

Received Date: 2023-01-05  Accepted Date: 2023-06-10 

基金项目：陕西省卫生健康科研项目（2022D063）

Foundation Item: Shaanxi Provincial Health Research Program (2022D063) 

通讯作者：李艳红，Email：yhlitdh@163.com 

Corresponding Author: LI Yanhong, Email: yhlitdh@163.com 

引用格式：赵宏喜，郭琳，刘菲，等 . 免举宫技术用于机器人辅助宫颈癌根治术的影响因素分析 [J]. 机器人外科学杂志（中英文）， 2024，5（2）：166-171. 

Citation: ZHAO H X, GUO L, LIU F, et al. Analysis of influencing factors on robot-assisted radical hysterectomy for cervical cancer without uterine manipulator[J]. Chinese Journal of Robotic Surgery, 2024, 5(2): 166-171.

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