关键词： 机器人辅助单孔腹腔镜；传统腹腔镜；子宫内膜癌手术；妇科手术加速康复
刘小艳，吴治敏，陈梦越，侯丽，王延洲，梁志清，陈诚
探讨机器人辅助单孔腹腔镜技术在妇科手术加速康复中的作用。方法：回顾性分析陆军军医大学第一附属医院妇产科 2019 年 2 月 ~2019 年 9 月完成全面分期手术治疗的 29 例早期子宫内膜癌患者的临床资料。结果：在加速康复外科理念指导下，29 例患者均在完全腹腔镜下完成筋膜外全子宫切除 + 双侧附件切除 + Ⅱ级盆腔淋巴结切除术，其中机器人辅助单孔腹腔镜手术组 9 例，传统腹腔镜手术组 20 例。单孔机器人组年龄小于传统腹腔镜组、手术时间长于传统腹腔镜、术后疼痛评分小于传统腹腔镜组，差异有统计学意义（P<0.05）；单孔机器人组的下床活动时间、引流管留置时间和术后住院时间均短于传统腹腔镜组，差异有统计学意义（P<0.05）；两组在手术出血量、手术并发症（脏器、神经或血管损伤等）、术后肛门排气时间、尿管留置时间以及术后并发症（下肢静脉血栓、感染、肠梗阻等）方面比较，差异无统计学意义（p>0.05）。结论：机器人辅助单孔腹腔镜实施子宫内膜癌全面分期手术安全可行；该技术有助于促进妇科手术加速康复，缩短术后住院时间，促进医疗资源合理利用。
To explore the effect of robotic-laparoendoscopic single-site (R-LESS) in enhanced recovery after surgery (ERAS) in gynecology. Methods: Retrospective analysis of clinical data of 29 patients with early endometrial cancer who completed comprehensive staging surgery in the First Affiliated Hospital of Army Military Medical University from February 2019 to September 2019. Results: Under the guidance of ERAS, 29 cases underwent complete laparoscopic total fascial hysterectomy + bilateral appendectomy + class Ⅱ pelvic lymphadenectomy, of which 9 patients were in the R-LESS group, the other 20 were in the traditional laparoscopic group. The R-LESS group is younger than the traditional laparoscope group (P<0.05), the operation time is longer than the traditional laparoscope group (P<0.05), and the postoperative pain score is lower than the traditional laparoscope group (P<0.05). The time of getting out of bed, drainage tube indwelling time and postoperative hospital stay in the R-LESS group were shorter than those in the traditional laparoscopic group (P<0.05); There were no differences in surgical bleeding, surgical complications (visceral、nerve or vascular injury, etc.), postoperative anal exhaust time, urinary indwelling time, and postoperative complications (lower limb venous thrombosis, infection, intestinal obstruction, etc.) between two groups (P<0.05). Conclusion: R-LESS is safe and feasible for the comprehensive staging of endometrial cancer, it helps to accelerate recovery in gyecological operation, shorten the length of postoperative hospitalization and optimize medical resources.