机器人手术系统辅助食管癌根治术与胸腹腔镜联合食管癌根治术的近期疗效比较

Comparison of short-term efficacy between robot-assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy for esophageal cancer

摘要:

目的：比较机器人手术系统辅助微创食管癌根治术（robot-assisted minimally invasive esophagectomy，RAMIE）与胸腹腔镜联合食管癌根治术（video-assisted minimally invasive esophagectomy，VAMIE）的近期疗效。方法：收集2016年1月至2018年3月在我院未行任何术前新辅助治疗并接受微创食管癌根治术的67例患者临床及病理资料。67例患者中，34例行RAMIE，设为机器人组，33例行VAMIE，设为胸腹腔镜组。结果：与胸腹腔镜组相比，机器人组的手术时间更长[（387.4±108.5） min vs.（320.6±65.6） min；Z=-2.598；P=0.009]。机器人组清扫淋巴结平均数量明显多于胸腹腔镜组[（25.5±6.2） vs. （21.9±7.1）；Z=-2.003；P=0.045]。机器人组和胸腹腔镜组在术中失血量[（180.9±383.1） mL vs.（222.1±431.4） mL；t=-0.464；P=0.644]，术后平均住院时间[（16.7±9.8） d vs.（16.0±9.8） d；Z=-0.088；P=0.930]以及总体并发症（32.4％ vs. 36.4％； χ2=0.119；P=0.730）之间无明显统计学意义。结论：与VAMIE相比，RAMIE治疗食管癌安全可行，且可以清扫更多的淋巴结。

Abstract:

Objective：To compare the short-term efficacy between robot-assisted minimally invasive esophagectomy（RAMIE） and video-assisted minimally invasive esophagectomy（VAMIE） for esophageal cancer. Methods：The clinical data of 67 patients were collected who underwent minimally invasive esophagectomy（RAMIE or VAMIE） without any preoperative neoadjuvant therapy in our hospital from January 2016 to March 2018. Of the 67 patients，34 who underwent RAMIE were assigned to robot group，while the re－maining ones who underwent VAMIE were assigned to thoracoscope/laparoscope group. Results：The robot group had significantly longer operation time compared with the thoracoscope/laparoscope group[（387.4±108.5） min vs. （320.6±65.6） min，Z=-2.598，P=0.009]. The mean number of dissected lymph nodes was significantly higher in the robot group than in the thoracoscope/laparoscope group（25.5±6.2 vs. 21.9±7.1，Z=-2.003，P=0.045）. There were no significant differences between the robot group and the thoraco－scope/laparoscope group with respect to intraoperative blood loss[（180.9±383.1） mL vs. （222.1±431.4） mL，t=-0.464，P=0.644]，mean postoperative hospital stay[（16.7±9.8） d vs. （16.0±9.8） d，Z=-0.088，P=0.930]，and overall complications（32.4% vs. 36.4%，χ2=0.119，P=0.730）. Conclusions：Compared with VAMIE，RAMIE is safer and more feasible in the treatment of esophageal cancer and can remove more lymph nodes.