摘要
目的探讨达芬奇机器人手术系统与腹腔镜行远端胃癌根治术的临床疗效。方法采用倾向评分匹配及回顾性队列研究方法。收集2015年1月至2016年10月南昌大学第一附属医院收治的171例胃癌患者的临床病理资料;男110例,女61例;中位年龄57岁,年龄范围为38~81岁。171例患者中,70例行达芬奇机器人手术系统远端胃癌根治术设为机器人组,101例行腹腔镜远端胃癌根治术设为腹腔镜组。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较。(2)术中和术后情况。(3)病理学检查情况。(4)随访情况。采用门诊或电话方式进行随访,了解患者出院后严重并发症发生情况及生存情况。随访时间截至2018年10月。总生存时间定义为手术日至末次随访时间或患者死亡时间。倾向性评分匹配应用易侕统计软件按1∶1最近邻匹配法匹配。正态分布的计量资料以Mean±SD表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ^2检验。等级资料组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法计算生存率并绘制生存曲线,采用Log-rank检验进行生存分析。结果(1)倾向评分匹配情况及匹配后两组患者一般资料比较:171例患者中,124例(机器人组和腹腔镜组各62例)配对成功。机器人组和腹腔镜组倾向评分匹配前患者的体质量指数和肿瘤直径分别为(24.2±2.4)kg/m^2和(25.1±2.1)kg/m^2,(50±13)mm和(45±14)mm,两组比较,差异均有统计学意义(t=-2.676,2.045,P<0.05);经倾向评分匹配后两组上述指标分别为(24.5±2.3)kg/m^2和(24.4±2.2)kg/m^2,(49±14)mm和(48±12)mm,两组比较,差异均无统计学意义(t=0.110,0.524,P>0.05)。(2)术中和术后情况:倾向评分匹配后机器人组患者总手术时间、术中出血量、术后第1天C反应蛋白、术后第3天C反应蛋白、术后腹腔总引流量分别为(147±13)min、(115±12)mL、(52.2±7.2)mg/L、(33.7±11.9)mg/L、353.5 mL(267.0~1 350.0 mL);腹腔镜组上述指标分别为(140±12)min、(131±12)mL、(58.2±7.4)mg/L、(41.1±16.9)mg/L、397.0 mL(255.0~1 600.0 mL),两组比较,差异均有统计学意义(t=3.163,-7.814,-4.631,-2.840,Z=-4.351,P<0.05)。(3)病理学检查情况:倾向评分匹配后两组患者均达R0切除,十二指肠切缘及胃切缘均未见癌细胞累及。机器人组和腹腔镜组患者的淋巴结清扫数目分别为(22±4)枚和(20±4)枚,两组比较,差异有统计学意义(t=2.812,P<0.05)。(4)随访情况:倾向评分匹配后124例患者均获得术后随访,随访时间为6~37个月,中位随访时间为25个月。随访期间,术后3个月内两组患者均未出现输入襻和输出襻梗阻、倾倒综合征等手术相关的严重并发症。机器人组和腹腔镜组患者2年总体生存率分别为82.1%和75.2%,两组比较,差异无统计学意义(χ^2=0.436,P>0.05)。
Objective To investigate the clinical efficacy of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer. Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 171 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanchang University from January 2015 to October 2016 were collected. There were 110 males and 61 females, aged from 38 to 81 years, with a median age of 57 years. Of 171 patients, 70 undergoing Da Vinci robotic distal gastrectomy for gastric cancer and 101 undergoing laparoscopic distal gastrectomy were allocated into the robotic group and laparoscopic group, respectively. Observation indicators:(1) the propensity score matching conditions and comparison of general data between the two groups after the propensity score matching;(2) intraoperative and postoperative situations;(3) situations of pathological examination;(4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect severe complications and survival after discharge up to October 2018. The overall survival time was from the operation data to end of follow-up or time of death. The propensity score matching was used to perform 1∶1 matching by Empower Stats. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute number, and comparison between groups was analyzed using the chi-square test and comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between the two groups after the propensity score matching: 124 of 171 patients had successful matching, including 62 in each group. The body mass index (BMI) and tumor diameter before matching were (24.2±2.4)kg/m^2 and (50±13)mm in the robotic group,(25.1±2.1)kg/m^2 and (45±14)mm in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.676, 2.045, P<0.05). The BMI and tumor diameter after matching were (24.5±2.3)kg/m^2 and (49±14)mm in the robotic group,(24.4±2.2)kg/m^2 and (48±12)mm in the laparoscopic group, showing no statistically significant difference between the two groups (t=0.110, 0.524, P>0.05).(2) Intraoperative and postoperative situations: the total operation time, volume of intraoperative blood loss, level of C-reactive protein at day 1 postoperatively, level of C-reactive protein at day 3 postoperatively, volume of totally abdominal drainage were (147±13)minutes,(115±12)mL,(52.2±7.2)mg/L,(33.7±11.9)mg/L, 353.5 mL (range, 267.0-1 350.0 mL) in the robotic group, and (140±12)minutes,(131±12)mL,(58.2±7.4)mg/L,(41.1±16.9)mg/L, 397.0 mL (range, 255.0-1 600.0 mL) in the laparoscopic group, respectively, showing statistically significant differences in the above indexes between the two groups (t=3.163,-7.814,-4.631,-2.840, Z=-4.351, P<0.05).(3) Situations of pathological examination: patients after matching in the two groups received R0 resection, with negative duodenal margin and gastric margin. The number of lymph nodes dissected in the robotic group and laparoscopic group were 22±4 and 20±4, respectively, with a statistically significant difference between the two groups (t=2.812, P<0.05).(4) Follow-up: 124 patients after propensity score matching were followed up for 6-37 months, with a median time of 25 months. During the follow-up, no severe surgery-related complications such as obstruction of input or output loop and dumping syndrome were found in the two groups within 3 months after operation. The 2-year overall survival rate was 82.1% and 75.2% in the robotic and laparoscopic group, with no statistically significant difference between the two groups (χ^2=0.436, P>0.05). Conclusions Compared with laparoscopic surgery, Da Vinci robotic distal gastrectomy for gastric cancer has advantages in postoperative recovery and minimally invasion. There are similar 2-year overall survival rates in the two groups.
作者
叶善平
何鹏辉
唐博
唐城
江群广
刘东宁
雷雄
李太原
Ye Shanping;He Penghui;Tang Bo;Tang Cheng;Jiang Qunguang;Liu Dongning;Lei Xiong;Li Taiyuan(Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第3期244-249,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81560397).
关键词
胃肿瘤
胃癌
达芬奇机器人手术系统
腹腔镜检查
倾向评分匹配
临床疗效
Gastric neoplasms
Gastric cancer
Da Vinci robotic surgery system
Laparoscopy
Propensity score matching
Clinical efficacy
