摘要
目的:对比机器人与腹腔镜全直肠系膜切除术的短期临床疗效。方法:回顾分析2020年8月至2022年12月行机器人与腹腔镜全直肠系膜切除术的112例患者的临床资料。采用倾向评分匹配法对两组患者的临床资料进行1∶1匹配,两组各30例患者匹配成功,匹配后对比分析两组手术情况、术后恢复情况及术后30 d并发症。结果:匹配后两组患者临床资料差异无统计学意义(P>0.05)。机器人组中1例中转腹腔镜手术,腹腔镜组无中转开腹。两组左结肠动脉保留、盆底腹膜关闭、环周切缘阳性率、远切缘距离、淋巴结清扫数量差异无统计学意义(P>0.05)。机器人组预防性回肠造口率低于腹腔镜组,术中出血量少于腹腔镜组,吻合口加固缝合数量多于腹腔镜组,术后第1天C-反应蛋白水平低于腹腔镜组,总手术时间长于腹腔镜组,差异均有统计学意义(P<0.05);两组首次排气时间、拔除尿管时间、肛管留置时间、首次进食时间、术后住院时间、术后30 d并发症差异均无统计学意义(P>0.05)。结论:机器人全直肠系膜切除术可获得与腹腔镜手术相似的短期临床疗效,机器人手术时间更长,但具有组织损伤轻、术中出血少、回肠造口率低的优势。
Objective:To compare the short-term clinical effect of robotic and laparoscopic total mesorectal excision.Methods:The clinical data of 112 patients who underwent robotic or laparoscopic total mesorectal excision between Aug.2020 and Dec.2022 were retrospectively analyzed.Propensity score matching method was used to perform 1∶1 matching between the two groups.Thirty patients in each group were successfully matched,then the surgical indicators,postoperative recovery and postoperative complications within 30 d were compared between the two groups.Results:There were no statistically significant differences in baseline data after matching b etween the two groups(P>0.05).One case in robotic group converted to laparoscopic resection,no conversion occurred in the laparoscopic group.There were no statistical differences between the two groups in left colic artery preservation,close of pelvic peritoneum,positive circumferential resection margin,distal resection margin and the number of harvested lymph node(P>0.05).The rate of prophylactic ileostomy was lower,blood loss during operation was less,reinforcement suture of anastomotic stoma was more,the level of C-reactive protein on the first postoperative day was lower,while the total operation time was longer in the robotic group than those in the laparoscopic group(P<0.05).No significant differences were found in the time to first flatus,removing urinary catheter,removing anal tube,first fluid diet,postoperative hospital stay and postoperative complication within 30 d between the two groups(P>0.05).Conclusions:The robotic total mesorectal excision has the similar short-term clinical effect to the laparoscopic operation,although the robotic operation requires longer operation time,it has the advantage of light tissue injury,little blood loss and low rate of prophylactic ileostomy.
作者
张云
龚航军
韩刚
曹羽
张言言
张旭
胡建
刘芝亦
ZHANG Yun;GONG Hangjun;HAN Gang(Department of Gastrointestinal Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《腹腔镜外科杂志》
2024年第1期42-47,共6页
Journal of Laparoscopic Surgery
基金
上海市科学技术委员会科研计划项目(19401973000)。
关键词
直肠肿瘤
全直肠系膜切除术
机器人手术
腹腔镜检查
治疗结果
Rectal neoplasms
Total mesorectal excision
Robotic surgical procedures
Laparoscopy
Treatment outcome
