机器人辅助腹腔镜前列腺癌根治术与腹腔镜前列腺癌根治术术后疗效对比分析：倾向性评分匹配队列研究

A comparative analysis of the efficacy of robotic vs. laparoscopic radical prostatectomy: a propensity score matching cohort study

摘要:

目的 比较分析机器人辅助腹腔镜前列腺癌根治术（机器人手术）与腹腔镜前列腺癌根治术（腹腔镜手术）术后的疗效差异。方法 回顾性分析2017年1月至2022年12月在重庆医科大学附属第一医院泌尿外科接受机器人手术（253例）及腹腔镜手术（148例）术后患者的临床资料。通过倾向性评分进行1∶1匹配平衡2组基线特征后，比较2组患者发生术后切缘阳性、住院时间、住院费用的差异。结果 与腹腔镜手术相比，多因素logistic回归分析表明机器人手术切缘阳性危险比值比为1.17（OR=1.17，95%CI=0.61~2.25，P=0.640）。机器人组住院时间为13.5（10，17） d，腹腔镜手术组为13（10，18） d，组间差异无统计学意义（P=0.927）。机器人组患者住院总费用为72 695（65 479，78 623）元，腹腔镜手术组患者住院总费用为46 045（40 367，63 149）元，差异有统计学意义（P<0.001）。结论 在带来额外医疗费用的情况下，与腹腔镜手术相比，机器人手术在减少患者住院时间和术后切缘阳性发生率方面并不具有优势。

Abstract:

Objective To compare the efficacy of robot-assisted vs. laparoscopic radical prostatectomy.Methods A retrospective analysis was performed on the clinical data of patients with prostate cancer（253 patients undergoing robot-assisted radical prostatectomy and 148 patients undergoing laparoscopic radical prostatectomy） in the Department of Urology in The First Affiliated Hospital of Chongqing Medical University between January 2017 and December 2022. The two groups were compared for positive surgical margins，length of hospital stay，and hospital fees after the baseline characteristics of the two groups had been matched and balanced using propensity scores.Results Multivariate logistic analyses showed that the odds ratio（OR） of positive surgical margins for robot-assisted surgery（compared with laparoscopic surgery） was 1.17（OR=1.17，95%CI=0.61-2.25，P=0.640）. The length of hospital stay was 13.5（10，17） days in the robot-assisted group and 13（10，18） days in the laparoscopic group，showing no significant difference between the two groups（P=0.927）. The total hospital fee was 72 695（65 479，78 623） Yuan in the robot-assisted group and 46 045（40 367，63 149） Yuan in the laparoscopic group，showing a significant difference（P<0.001）.Conclusion In comparison to laparoscopic radical prostatectomy，robot-assisted surgery does not offer any advantage in reducing patients’ length of hospital stay and incidence of positive surgical margins while adding extra medical expenses.