目的 比较达芬奇机器人胃癌根治术与开腹胃癌根治术治疗胃癌的近期疗效.方法 选取2014年1月—2016年6月解放军总医院普通外科收治的胃癌患者97例,其中50例患者行开腹胃癌根治术(对照组)、47例患者行达芬奇机器人胃癌根治术(观察组).比较两组患者手术相关指标、病理学检查结果、术后情况,术前ld及术后1、3、7d外周血中性粒细胞计数(N)、淋巴细胞计数(L)及中性粒细胞计数与淋巴细胞计数比值(N/L),并观察两组患者术后并发症发生情况.结果 两组患者手术类型、淋巴结清扫数目、近端切缘距肿瘤距离、远端切缘距肿瘤距离、肿瘤大小及分化程度比较,差异无统计学意义(P＞0.05);观察组患者手术时间长于对照组,术中出血量少于对照组(P＜0.05).观察组患者术后首次进食时间和术后首次排气时间早于对照组,住院费用多于对照组(P＜0.05);两组患者住院时间比较,差异无统计学意义(P＞0.05).多变量重复测量方差分析结果显示,时间和方法在N、L及N/L上无交互作用(P＞0.05);时间在N、L及N/L上主效应显著(P＜0.05);方法在N、L及N/L上主效应不显著(P＞0.05).术后l、3、7d两组患者N、L及N/L比较,差异无统计学意义(P＞0.05).两组患者术后并发症发生率比较,差异无统计学意义(P＞0.05).结论 达芬奇机器人胃癌根治术与开腹胃癌根治术对细胞免疫的抑制作用及安全性相当,但达芬奇机器人胃癌根治术具有术中出血量少、术后患者胃肠功能恢复快等优势及手术时间长、手术费用高等不足.%Objective To compare the short-term curative effect on gastric carcinoma between Leonardo's robotic and open radical operation for gastric carcinoma.Methods From January 2014 to June 2016,a total of 97 patients with gastric carcinoma were selected in the Department of General Surgery,General Hospital of Chinese People's Liberation Army,thereinto 50 patients treated by open radical operation for gastric carcinoma were served as control group,other 47 patients treated by Leonardo's robotic radical operation for gastric carcinoma were selected as observation group.Operation related indicators,pathological examination results,postoperative situation,peripheral blood neutrophil count (N),lymphocyte count (L) and lymphocyte counteutrophil count ratio (N/L) before 1 day of operation,after 1 day,3 days and 7 days of operation were compared between the two groups,and incidence of postoperative complications was observed.Results No statistically significant differences of operationtypes,number of dissected lymphonodi,distance between proximal incisal edge and tumour,distance between distal incisal edge and tumour,tumor size or tumor differentiated degree was found between the two groups (P ＞ 0.05);duration of operation of observation group was statistically significantly longer than that of control group,intraoperative blood loss of observation group was statistically significantly less than that of control group (P ＜ 0.05).The first time to eat and pass gas after surgery were statistically significantly more early than those of control group,hospitalization costs of observation group was statistically significantly more than that of control group (P ＜ 0.05),while no statistically significant differences of hospital stays was found between the two groups (P ＞ 0.05).Multivariable repeated measurement variance analysis results showed that,there was no interaction between time and method in N,L or N/L (P ＞ 0.05);main effect of time was significant in N,L and N/L (P ＜ 0.05),while main effect of method was not significant in N,L or N/L (P ＞ 0.05).No statistically significant differences of N,L or N/L was found between the two groups after.1 day,3 days or 7 days of operation (P ＞0.05).No statistically significant differences of incidence of postoperative complications was found between the two groups (P ＞ 0.05).Conclusion Leonardo's robotic radical operation for gastric carcinoma has similar inhibiting effect on cellular immunity and safety with open radical operation for gastric carcinoma,can more effectively reduce the intraoperative blood loss and promote the recovery of postoperative gastrointestinal function,but may lengthen the duration of operation and increase the hospitalization costs.
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