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机器人与腹腔镜直肠癌TME 手术的近期疗效对照研究

关键词： 直肠癌；机器人手术；腹腔镜手术；近期疗效

王 赫，刘志鹏，李晶晶，朱成章，朱小龙，史新龙，吕耀春，吴德望，刘文涵，徐世赟，燕 东，张洪来，李来元，段耀星，胡东平，陈玲娟，杜斌斌，王 涛，王小英，张维胜，杨熊飞   

  • 1 No. 5 Dec. 2020
  • DIO:10.12180/j.issn.2096-7721.2020. 05.002 发布日期:2021-04-11 阅读数:590
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  • 作者简介:

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目的：对比达芬奇机器人与腹腔镜应用于直肠癌全系膜切除术（Total mesorectal excision，TME）的近期疗效。方法：回顾性分析2019 年1 月~2019 年12 月甘肃省人民医院肛肠科235 例行直肠癌全系膜切除术患者的临床资料，其中机器人组120 例，腹腔镜组115 例，比较两组患者的手术情况、术后恢复情况、术后并发症及肿瘤学结果。结果：与腹腔镜组相比，机器人组出血量少[（123.7±103.4）ml Vs （167.2±118.5）ml；t=-2.999，P=0.003]，通气时间短[（79.2±22.9）h Vs （118.3±28.1）h；t=-11.762，P<0.001]，进食流质饮食时间短[（91.0±16.8）h Vs （123.0±21.0）h；t=-12.968，P<0.001]， 腹腔引流量少[（315.4±282.8）ml Vs （397.0±327.9）ml；t=-2.045，P=0.042]，术后住院时间短[（8.1±2.6）d Vs （8.9±2.5）d；t=-2.406，P=0.017]。然而，机器人组住院总费用高于腹腔镜组[（80 193.9±14 934.2）元Vs（65 791.0±17 399.0）元；t=6.823，P<0.001]。两组手术时间、淋巴结清扫、腹腔引流管留置时间、术后并发症和肿瘤学结果的差异无统计学意义。结论：相比于腹腔镜手术，机器人手术出血量少、住院时间短、术后胃肠道功能恢复快，可作为直肠癌TME 手术治疗的有效途径之一。

Objective: To compare the short-term outcomes of conventional laparoscopic total mesorectal excision (L-TME) and robot-assisted total mesorectal excision (R-TME) on rectal cancer. Methods: A total of 235 patients underwent R-TME (120) or L-TME (115) after diagnosed with rectal cancer from January 2019 to December 2019 were included in this study. Patients’ characteristics, perioperative characteristics and pathologic characteristics were evaluated between the R-TME group and the L-TME group. Results: Compared with the L-TME group, the R-TME group showed less intraoperative blood loss (123.7ml Vs 167.2ml, P=0.003), less first flatus time (79.2h Vs 118.3h, P<0.001), less first liquid diet time (91.0h Vs 123.0h, P<0.001), less volume of abdominal drainage (315.4ml Vs 397.0ml, P=0.042) and shorter hospital stay (8.1d Vs 8.9d, P=0.017) . However, the R-TME group had more expensive total hospitalization costs (80 193.9CNY Vs 65 791.0CNY, P<0.001). No significant differences were observed between the two groups in respect to operation time, total number of examined lymph nodes, time of abdominal drainage and postoperative complications. The pathologic characteristics of the two groups were not significantly different. Conclusion: This study shows that the robot-assisted total mesorectal excision is superior to laparoscopic one in terms of short-term outcomes in surgeries of rectal cancer, it is safe and feasible to treat rectal cancer.