三臂与二臂机器人辅助直肠癌根治术近期疗效比较

摘要

目的 比较应用3只机械臂的机器人辅助直肠癌根治术(Dixon式)与应用2只机械臂的机器人直肠癌根治术(Dixon式)的临床效果.方法 回顾性分析2014年9月-2016年10月于解放军总医院普通外科二病区行机器人辅助直肠癌根治术110例的临床资料.观察组50例,行3只机械臂的机器人辅助直肠癌根治术;对照组60例,行2只机械臂的机器人辅助直肠癌根治术.比较两组手术时间、术中出血量、淋巴结清扫数目、术后留置导尿管时间、留置胃管时间、首次下床时间、进食流质食物时间、术后并发症(切口感染、切口疝、吻合口瘘、术后出血量)出现的发生率、手术相关费用、患者住院时间.结果 两组患者基线资料差异无统计学意义.观察组手术时间(136.4±4.5) min,对照组(152.8±3.9) min (P=0.005);观察组留置胃管时间(43.9±0.6)h,对照组(48.6±0.8)h (P=0.001);观察组首次下床时间(15.9±0.5)h,对照组首次下床时间(18.9±0.7)h (P=0.000);观察组留置导尿管时间(46.1±2.6)h,对照组留置导尿管时间(47.6±2.2)h(P=0.350);观察组淋巴结清扫数平均(15.9±0.6)个,对照组(15.0±0.7)个(P=0.053);观察组手术出血量(45.9±10.9) ml,对照组(59.3±16.3) ml(P=0.036);观察组住院时间(8.12±1.66)d,对照组(10.67±1.72)d (P=0.035);观察组住院费用(10.4±0.3)万元,对照组住院费用(8.1±0.5)万元(P=0.002);观察组术后并发症发生率10％(5/50),对照组术后并发症发生率13％(8/60)(P=0.780).结论 应用3只机械臂的机器人辅助直肠癌根治术具有出血少、术后恢复快、手术效率高等优点,近期临床效果满意,但患者手术相关费用较高.%Objective To compare the clinical outcomes of robot-assisted anterior resection of rectum between 3-arm and 2-arm system.Methods Clinical data about 110 cases with rectal cancer who received robot-assisted anterior resection of rectum from Sept.2014 to Oct.2016 were reviewed.Fifty patients who received robot-assisted anterior resection of rectum with 3-arm system were chosen as the observation group and 60 patients who received robot-assisted anterior resection with 2-arm system were the control group.Results The baseline data were well matched in two groups.Compared to the control group,the surgery using 3 robot arms had the advantage of shorter operating time [(136.4 ± 4.5) min vs (152.8 ± 3.9) min,P=0.005],less blood loss [(45.9 ±10.9) ml vs (59.3 ± 16.3) ml,P=0.036],shorter period of indwelling gastric tube [(43.9 ± 0.6) h vs (48.6 ± 0.8) h,P=0.001],shorter time to ambulation [(15.9 ± 0.5) h vs (18.9 ± 0.7) h,P=0.000],shorter hospital stay [(8.12 ± 1.66) d vs (10.67 ± 1.72) d,P=0.036],but the cost was higher than the control group [(10.4 ± 0.3) ten thousand yuan vs (8.1 ± 0.5) ten thousan yuan,P=0.002].In addition,the period of indwelling urinary catheter and postoperative complications were not significant different between observation group and control group.Conclusion The robot-assisted anterior resection with 3 robotic arms is feasible and safe for rectal cancer patients comparing with using 2 robot arms.Quick recovery and satisfying short-term clinical outcomes are achieved,but the cost is high.