达芬奇机器人系统与腹腔镜在子宫内膜癌手术治疗中的对比分析

摘要/Abstract

摘要目的：对比并探讨达芬奇机器人手术系统与传统腹腔镜手术在子宫内膜癌手术治疗中的安全性、有效性，并进行自我效能分析。方法：回顾性分析 2015 年 9 月 ~2020 年 1 月上海交通大学医学院附属仁济医院妇产科收治的同一术者进行初始手术治疗的 137 例子宫内膜恶性肿瘤患者，其中达芬奇机器人组 64 例，腹腔镜组 73 例。统计分析两组患者手术时间、术中出血量、淋巴结切除数目、术后肛门排气时间、术后引流放置时间、住院时间、术后自我效能评价。结果：达芬奇机器人组和腹腔镜组比较，患者手术时间、术中出血量、术后肛门排气时间、术后引流放置时间、住院时间差异有统计学意义（P<0.05）；清扫淋巴结数量无差异（P>0.05）。且达芬奇机器人组较腹腔镜组患者术后自我效能感评估更佳（P=0.001）。结论：对于子宫内膜癌的手术治疗，达芬奇机器人手术系统较传统腹腔镜手术能够缩短患者恢复时间，在保证手术安全性下可以提高有效性。且达芬奇机器人较腹腔镜手术治疗子宫内膜恶性肿瘤患者术后自我效能感更佳，更利于子宫内膜癌患者术后心理康复。

Objective: To compare the clinical effectiveness and safety of Da Vinci robotic system and laparoscopic surgery in the treatment of endometrial carcinoma. Methods: 137 patients with endometrial cancer in obstetrics and gynecology department of Renji Hospital from September 2015 to January 2020 were selected, of which 64 cases underwent Da Vinci robotic surgery (Robotic group) and 73 cases underwent laparoscopic surgery (laparoscopic group). The basic information, data of operation index and postoperative self-efficacy of all cases were collected and analyzed. Results: Comparing to laparoscopic group, the robotic group showed significant advantages in respect to operative time, blood loss, hospital stay and self-efficacy, the difference was statistically significant. No significant differences between the two groups were found on lymph node dissection (P> 0.05). Conclusion: Da Vinci robotic surgery offers a feasible, effective and safe alternative in the surgical treatment of endometrial cancer. Compared with laparoscopic surgery, Da Vinci robot-assisted surgery shows better self-efficacy and faster psychological recovery after surgery of endometrial carcinoma.

稿件信息

参考文献

[1] Goday A, Barneto I, Garcia-Almeida J M, et al. Obesity as a risk factor in cancer: A national consensus of the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology[J]. Clinical & Translational Oncology, 2015, 17(10): 763-771.

[2] 中华人民共和国卫生部 . 中国居民营养与健康现状 [J]. 中国保健营养 , 2004, 13(11): 8-11.

[3] 田东立 , 李丰鑫 , 窦磊 , 等 . 达芬奇机器人系统在肥胖患者手术中的应用优势——附 1 例病例分析 [J]. 妇产与遗传 ( 电子版 ), 2019, 9(2): 30-32.

[4] Kawachi A, Shimazu T, Budhathoki S, et al. Association of BMI and height with the risk of endometrial cancer, overall and by histological subtype: a population-based prospective cohort study in Japan[J]. European Journal of Cancer Prevention, 2019, 28(3): 196-202.

[5] 杨曦 , 马珂 , 吴成 . 子宫内膜癌的流行病学及高危因素 [J]. 实用妇产科杂志 , 2015, 31(7): 485-488.

[6] Giannini A, Malacarne E, Sergiampietri C, et al. Comparison of perioperative outcomes and technical features using da Vinci Si and Xi robotic platforms for early stages of endometrial cancer[J]. Journal of Robotic Surgery, 2020. DOI: 10. 1007/s11701-020-01091-6.

[7] 钱会娟 , 袁长蓉 . 中文版癌症自我管理效能感量表的信效度测评 [J]. 中华护理杂志 , 2011, 46(1): 87- 89.

[8] 王宇 , 宋淑芳 . 我国子宫内膜癌流行病学特征及发病高危因素的研究进展 [J]. 世界最新医学信息文摘 , 2018, 18(16): 47-48.

[9] Torre L A, Islami F, Siegel R L, et al. Global cancer in women: Burden and trends[J]. Cancer Epidemiology Biomarkers & Prevention, 2017, 26(4): 444-457.

[10] 谢玲玲 , 林荣春 . 《2020 NCCN 子宫肿瘤临床实践指南 ( 第 1 版 )》解读 [J]. 中国实用妇科与产科杂志 , 2020, 36(4): 333-339.

[11] 金碧霞 , 孔为民 . 《国际妇产科联盟 (FIGO)2018 癌症报告 : 子宫内膜癌诊治指南》解读 [J]. 中国临床医生杂志 , 2019, 47(10): 1155-1158.

[12] Deura I, Shimada M, Azuma Y, et al. Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed lowrisk endometrial cancer: the current state of Japan[J]. Taiwanese Journal of Obstetrics & Gynecology, 2019, 58(1): 99-104.

[13] 王卫杰 , 高玲玲 , 徐建波 , 等 . 达芬奇机器人手术系统与腹腔镜手术在子宫内膜癌全面分期手术中安全性和有效性的 Meta 分析 [J]. 中华妇幼临床医学杂志 ( 电子版 ), 2018, 14(3): 296-304.

[14] Jørgensen S L, Mogensen O, Wu C S, et al. Nationwide introduction of minimally invasive robotic surgery for early-stage endometrial cancer and its association with severe complications[J]. JAMA Surgery, 2019, 154(6): 530-538.

[15] 晏红 , 付晓宇 , 李燕 , 等 . 机器人手术系统在妇科领域的应用及发展 [J]. 中国医学教育技术 , 2017, 31(2): 196-199.

[16] WEI L C, LI X, ZHANG Y, et al. Individualized pelvic lymphadenectomy should follow neoadjuvant concurrent chemoradiotherapy for locally advanced cervical cancer[J]. Medicine, 2018, 97(14): e0331.

[17] Oberman B, Khaku A, Camacho F, et al. Relationship between obesity, diabetes and the risk of thyroid cancer[J]. American Journal of Otolaryngology, 2015, 36(4): 535-541.

[18] 王海波 , 高丽彩 , 李秀娟 , 等 . 腹腔镜与开腹手术治疗肥胖妇女早期子宫内膜癌的对比研究 [J]. 中国微创外科杂志 , 2015, 15(6): 515-517.

[19] HUANG L Y, JI M, ZHAO Z, et al. The Da Vinci robotic-assisted operation in comprehensive staging of endometrial carcinoma[J]. Henan Journal of Surgery, 2019, 25(2): 19-21.

[20] 齐金红 , 袁勇 , 冯文娟 , 等 . 达芬奇机器人行妇科手术 11 例临床分析 [J]. 中华腔镜外科杂志 ( 电子版 ), 2017, 10(6): 370-375.

[21] Johansson C, Chan F. Robotic-assisted vs conventional laparoscopic hysterectomy for endometrial cancer[J]. Journal of Minimally Invasive Gynecology, 2019, 26(7): S74-S75.

[22] Cosin J A, Brett Sutherland M A, Westgate C T, et al. Complications of robotic gynecologic surgery in the severely morbidly obese[J]. Annals of Surgical Oncology, 2016, 23(12): 1-7.

[23] Bayraktar O, Aytac E, Özben V, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer?[J]. Surg Laparosc Endosc Percutan Tech, 2018, 28(1): e8-e11.

[24] Wysham Weiya Z, Kim Kenneth H, Roberts Jared M, et al. Obesity and perioperative pulmonary complications in robotic gynecologic surgery[J]. American Journal of Obstetrics and Gynecology, 2015, 213(1): 33. e1-33. e7

[25] Seamon L G, Bryant S A, Rheaume P S, et al. Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy[J]. Obstetrics & Gynecology, 2009, 114(1): 16-21.

[26] 梁卫弟 , 罗宝嘉 , 吴晓丹 , 等 . 达芬奇机器人对比腹腔镜 / 开腹手术切除直肠癌患者自我效能及抑郁状况分析 [J]. 广东医学 , 2019, 40(18): 2637-2640, 2644.

[27] CHEN H L, LIU K, YOU Q S. Self-efficacy, cancerrelated fatigue, and quality of life in patients with resected lung cancer[J]. European Journal of Cancer Care, 2018, 27(6): e12934.

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