机器人手术系统与腹腔镜辅助直肠TME手术的回顾性对比分析

Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer

摘要:

目的： 比较达芬奇机器人和腹腔镜行直肠癌TME手术的近期临床疗效。方法： 回顾性分析2017年1月至2020年1月甘肃省人民医院肛肠科365例行直肠癌TME手术的患者临床资料，根据手术方式不同分为2组，其中机器人组175例，腹腔镜组190例，比较2组术中、术后和随访情况。结果： 相比于腹腔镜组，机器人组术中出血量明显较少[（94.8±55.6）mL vs.（127.4±42.1）mL，t=-2.739，P=0.007]；术后排气时间较短[（60.3±11.9）h vs.（78.8±12.3）h，t=-12.189，P=0.000]；首次流质饮食时间较短[（89.0±15.0）h vs.（113.7±10.1）h，t=-13.597，P=0.000]；术后住院时间较短[（8.5±1.7）d vs.（10.2±2.4）d，t=-4.150，P=0.000]；但机器人组住院总费用较多[（83 538.1±10 911.0）元 vs.（70 640.4±11 659.0）元，t=6.338，P=0.000]。机器人组和腹腔镜组手术时间[（202.9±14.7）min vs.（207.0±14.2）min，t=0.566，P=0.572]、引流管留置时间[（5.9±1.4）d vs.（6.0±1.4）d，t=-0.516，P=0.557]和引流量[（202.7±87.0）mL vs.（200.0±87.1）mL，t=0.335，P=0.738]的差异无统计学意义。2组淋巴结清扫结果、肿瘤学结果和术后总体并发症的差异均无统计学意义（P>0.05）；2组环周切缘均为阴性。2组患者围手术期均无死亡。随访情况方面，机器人组175例（失访16例）平均随访17.4个月，3例老年患者因其他基础疾病死亡；腹腔镜组190例（失访23例）平均随访16.9个月，6例老年患者因其他基础疾病死亡。2组患者随访过程中均无复发，无腹壁切口疝、造口旁疝、造口坏死等严重并发症。结论： 相比于腹腔镜手术，机器人直肠癌TME手术出血量少且术后胃肠道功能恢复快，安全可行，值得在临床推广应用。

Abstract:

Objective: To compare short-term outcomes between robotic-assisted and laparoscopic total mesorectal excision (TME) for rectal cancer. Methods: A total of 365 patients diagnosed with rectal cancer in Gansu Provincial Hospital from January 2017 to January 2020 were included in this study, among which 175 patients underwent robotic-assisted TME (R-TME group) and 190 patients underwent laparoscopic TME (L-TME group). The data of intra-operative, post-operative and clinical follow-up were compared between the two groups. Results: Compared to the L-TME group, the R-TME group had significantly less amount of bleeding [ (94.8±55.6) mL vs. (127.4±42.1) mL, t=-2.739, P=0.007], shorter first aerofluxus time [ (60.3±11.9) h vs. (78.8±12.3) h, t=-12.189, P=0.000], shorter first liquid diet time [ (89.0±15.0) h vs. (113.7±10.1) h, t=-13.597, P=0.000], shorter postoperative hospital stay [ (8.5±1.7) d vs. (10.2±2.4) d, t=-4.150, P=0.000], but more in-patient costs [ (83 538.1±10 911.0) vs. (70 640.4±11 659.0), t=6.338, P=0.000]. There were no significant differences between the two groups in operation time [ (202.9±14.7) min vs. (207.0±14.2) min, t=0.566, P=0.572], postoperative drainage time [ (5.9±1.4) d vs. (6.0±1.4) d, t=-0.516, P=0.557], and the volume of drainage [ (202.7±87.0) mL vs. (200.0±87.1) mL, t=0.335, P=0.738]. There was no significant difference in lymph node dissection, oncological results and overall postoperative complications between the two groups (P>0.05). The circumferential resection margin was negative in both groups. There was no death during the perioperative period. In terms of follow-up, 175 patients (16 lost) in the R-TME group were followed up for an average of 17.4 months, and 3 elderly patients t died of other basic diseases. In the L-TME group, 190 patients (23 lost) were followed up for an average of 16.9 months, and 6 elderly patients died of other basic diseases. No serious complications such as recurrence, incisional abdominal wall hernias and ostomy-related diseases occurred during the follow-up of the two groups. Conclusion: Compared with laparoscopic surgery, R-TME for rectal cancer with less bleeding and faster recovery of gastrointestinal function post operation, is safe, effective and worthy of clinical application.