机器人与腹腔镜辅助中低位直肠癌根治术近期疗效比较的单中心随机对照研究
| 作者: |
1邹震,
1唐博,
1刘东宁,
1江群广,
1唐城,
1李太原
1 南昌大学第一附属医院 普外五科，江西 南昌 330006 |
| 通讯: |
李太原
Email: jylitaiyuan@sina.com |
| DOI: | 10.3978/.2018.04.004 |
| 基金: | 国家自然科学基金资助项目（81402401）。 |
摘要
目的：比较分析机器人与腹腔镜手术治疗中低位直肠癌的近期临床疗效。
方法：选择南昌大学第一附属医院2016年10月—2017年5月连续收治的100例中低位直肠癌（肿瘤下缘距离肛缘≤12 cm）患者，按照序贯原则设计，随机分为机器人组和腹腔镜组，各50例，分别行机器人和腹腔镜辅助中低位直肠癌根治术。比较两组患者相关临床指标。
结果：两组术前资料无统计学差异（均P>0.05）。所有患者均顺利完成手术，无中转开腹手术者。两组术后环周切缘均阴性，机器人组切除的直肠系膜均完整，腹腔镜组有1例直肠系膜完整性被破坏。与腹腔镜组比较，机器人组平均术中出血量（67.1 mL vs. 134.6 mL）、手术时间（123.2 min vs. 152.6 min）、术后胃肠道功能恢复时间（45.7 h vs. 51.8 h）、饮食恢复时间（52.9 h vs. 64.3 h）、尿管拔除时间（4.4 d vs. 4.9 d）均明显减少，但平均住院费用明显高于腹腔镜组（5.6万元vs. 4.2万元）及手术费用（3.1万元vs. 1.7万元）明显增加（均P<0.05）。两组的手术方式、标本切除长度、淋巴结清扫数目、术后病理、术后住院时间、非手术费用以及术后并发症发生率方面均无统计学差异（均P>0.05）。
结论：机器人手术治疗中低位直肠癌患者安全可行，较腹腔镜手术具有创伤小、恢复快等优点。
关键词：
直肠肿瘤；机器人手术；腹腔镜；疗效比较研究
方法：选择南昌大学第一附属医院2016年10月—2017年5月连续收治的100例中低位直肠癌（肿瘤下缘距离肛缘≤12 cm）患者，按照序贯原则设计，随机分为机器人组和腹腔镜组，各50例，分别行机器人和腹腔镜辅助中低位直肠癌根治术。比较两组患者相关临床指标。
结果：两组术前资料无统计学差异（均P>0.05）。所有患者均顺利完成手术，无中转开腹手术者。两组术后环周切缘均阴性，机器人组切除的直肠系膜均完整，腹腔镜组有1例直肠系膜完整性被破坏。与腹腔镜组比较，机器人组平均术中出血量（67.1 mL vs. 134.6 mL）、手术时间（123.2 min vs. 152.6 min）、术后胃肠道功能恢复时间（45.7 h vs. 51.8 h）、饮食恢复时间（52.9 h vs. 64.3 h）、尿管拔除时间（4.4 d vs. 4.9 d）均明显减少，但平均住院费用明显高于腹腔镜组（5.6万元vs. 4.2万元）及手术费用（3.1万元vs. 1.7万元）明显增加（均P<0.05）。两组的手术方式、标本切除长度、淋巴结清扫数目、术后病理、术后住院时间、非手术费用以及术后并发症发生率方面均无统计学差异（均P>0.05）。
结论：机器人手术治疗中低位直肠癌患者安全可行，较腹腔镜手术具有创伤小、恢复快等优点。
Short-term outcomes of robotic versus laparoscopic radical resection for middle and low rectal cancer: a single-center randomized, controlled study
CorrespondingAuthor:LI Taiyuan Email: jylitaiyuan@sina.com
Abstract
Objective: To compare the short-term outcomes of robotic and laparoscopic radical resection for middle and low rectal cancer.
Methods: A total of 100 consecutive patients with middle and low rectal cancer (the inferior margin of the lesion locating no more than 12 cm from the anal verge) admitted in the First Affiliated Hospital of Nanchang University from October 2016 to May 2017 were enrolled. Based on the principle of sequential design, the patients were randomly assigned to robotic group and laparoscopic group with 50 cases in each group, and underwent robotic and laparoscopic middle and low rectal cancer radical surgery respectively. The main clinical variables between the two groups of patients were compared.
Results: There were no differences in preoperative data between the two groups (all P>0.05). Operations were successfully performed in all patients, without any open conversion. Negative circumferential resection margins were achieved in both groups and the integrity of mesorectum was impaired in one case in laparoscopic group. In robotic group compared with laparoscopic group, the average intraoperative blood loss (67.1 mL vs. 134.6 mL),
operative time (123.2 min vs. 152.6 min), time for postoperative gastrointestinal function recovery (45.7 h vs. 51.8 h), time to first postoperative food intake (52.9 h vs. 64.3 h) and time to urinary catheter removal (4.4 d vs. 4.9 d) were significantly reduced, but the average hospitalization cost (56 000 yuanvs. 42 000 yuan) and costs associated with surgery (31 000 yuanvs. 17 000 yuan) were significantly increased (all P<0.05). There were no significant differences in surgical procedures, length of the resected specimen, number of the resected lymph nodes, postoperative pathological results, length of postoperative hospital stay and non-surgery costs between the two groups (all P>0.05).
Conclusion: Robotic surgery for middle and lower rectal cancer is safe and feasible, and has advantages of less trauma and fast postoperative recovery in comparison to laparoscopic surgery.
Keywords：
Rectal Neoplasms; Robotic Surgical Procedures; Laparoscopes; Comparative Effectiveness Research
Methods: A total of 100 consecutive patients with middle and low rectal cancer (the inferior margin of the lesion locating no more than 12 cm from the anal verge) admitted in the First Affiliated Hospital of Nanchang University from October 2016 to May 2017 were enrolled. Based on the principle of sequential design, the patients were randomly assigned to robotic group and laparoscopic group with 50 cases in each group, and underwent robotic and laparoscopic middle and low rectal cancer radical surgery respectively. The main clinical variables between the two groups of patients were compared.
Results: There were no differences in preoperative data between the two groups (all P>0.05). Operations were successfully performed in all patients, without any open conversion. Negative circumferential resection margins were achieved in both groups and the integrity of mesorectum was impaired in one case in laparoscopic group. In robotic group compared with laparoscopic group, the average intraoperative blood loss (67.1 mL vs. 134.6 mL),
operative time (123.2 min vs. 152.6 min), time for postoperative gastrointestinal function recovery (45.7 h vs. 51.8 h), time to first postoperative food intake (52.9 h vs. 64.3 h) and time to urinary catheter removal (4.4 d vs. 4.9 d) were significantly reduced, but the average hospitalization cost (56 000 yuanvs. 42 000 yuan) and costs associated with surgery (31 000 yuanvs. 17 000 yuan) were significantly increased (all P<0.05). There were no significant differences in surgical procedures, length of the resected specimen, number of the resected lymph nodes, postoperative pathological results, length of postoperative hospital stay and non-surgery costs between the two groups (all P>0.05).
Conclusion: Robotic surgery for middle and lower rectal cancer is safe and feasible, and has advantages of less trauma and fast postoperative recovery in comparison to laparoscopic surgery.