中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (08): 906-912.DOI: 10.19538/j.cjps.issn1005-2208.2022.08.12

• 论著 • 上一篇    下一篇

机器人与腹腔镜直肠癌根治术疗效对比分析：一项倾向性评分匹配队列研究

谭    可，胡    康，田    跃 ，郑恢超，赵    松，黄    彬，王    李，李    凡，李春穴，张安平，刘宝华，童卫东   

  1. 陆军军医大学大坪医院普通外科，重庆400042
  • 出版日期:2022-08-01 发布日期:2022-08-12

  • Online:2022-08-01 Published:2022-08-12

摘要： 目的    比较分析机器人与腹腔镜直肠癌根治术的临床疗效。方法    回顾性分析2016-07-01—2021-03-31在陆军军医大学大坪医院普通外科接受机器人（151例）及腹腔镜（1021例）直肠癌根治术病人的临床资料。通过倾向性评分后进行1∶1匹配，将病人分为机器人组和腹腔镜组（两组各150例），比较二组病人术后30 d短期结局及术后3年生存结局。结果    两组术后30 d Clvien-Dindo分级（CDC）、总并发症发生率、严重并发症发生率差异均无统计学意义。机器人组吻合口瘘发生率低于腹腔镜组（6.6% vs. 14.6%，χ2=4.212，P=0.040），其余各种并发症两组间差异均无统计学意义。与腹腔镜组相比，机器人组中转开放手术率（2.0% vs. 6.7%，χ2=3.940，P=0.047）和30 d再手术率（2.7% vs. 9.3%，χ2=5.910，P=0.015）更低，且淋巴结检出数目更多［13（10～16）枚vs. 11（8～14）枚，Z=-3.662，P=0.000］、术后住院时间更短［7（6～9）d vs. 8（7～11）d，Z=-4.601，P=0.000］、手术时间更长［（197.0±54.6）vs.（151.3±51.8）min，t=7.386，P=0.000］、住院总费用更高［（94518.3±15670.7）vs. （81358.4±20228.5）元，t=6.229，P=0.000］。两组保肛率等其余短期结局差异无统计学意义。两组术后3年总生存率及无病生存率差异无统计学意义，但在分层分析中，Ⅲ期病人中机器人组3年总生存率更高（91.3% vs. 67.9%，χ2=3.988，P=0.046）。结论    与腹腔镜直肠癌根治术相比，机器人手术同样安全、有效，而且在改善吻合口瘘发生率等短期结局与提高部分病人的生存率方面有潜在优势。

关键词: 直肠癌, 机器人手术, 腹腔镜, 术后并发症, 生存结局

Abstract: Comparative analysis on clinical effects of robotic and laparoscopic radical resection for rectal cancer : A propensity score matched cohort study        TAN Ke, HU Kang, TIAN Yue, et al. Department of General Surgery, Daping Hospital, Army Medicial University, Chongqing 400042,China
Corresponding author:TONG Wei-dong, E-mail: vdtong@163.com
Abstract    Objective    To investigate the therapeutic effects of robotic and laparoscopic radical resection for rectal cancer. Methods    The clinical data of patients who underwent robotic(151 cases) or laparoscopic radical resection(1021 cases) surgery for rectal cancer in Department of General Surgery, Daping Hospital, Army Medical University from July 1, 2016 to March 31, 2021 were analyzed retrospectively. Patients in robotic and laparoscopic group were matched 1∶1 by propensity score,150 cases were included in each group,30-day short-term outcomes and 3-year survival outcomes were compared between the two groups. Rusults    There were no significant differences between two groups in 30-day Clavien-Dindo classification (CDC), total complication rate, and severe complication rate. Anastomotic leakage rate is lower in robotic group than laparoscopic group(6.6% vs. 14.6%, χ2=4.212, P=0.040). Other various complications were almost similar in two groups. Compared to laparoscopic surgery, robotic surgery was associated with lower conversion rate (2.0% vs. 6.7%, χ2=3.940, P=0.047) and 30-day reoperation rate (2.7% vs. 9.3%, χ2=5.910, P=0.015), more number of retrieved lymph nodes ［13(10～16) vs. 11(8～14), Z=-3.662, P=0.000］, shorter postoperative length of stay ［7(6～9) vs. 8(7～11), Z=-4.601, P=0.000］, longer operative time ［(197.0±54.6) vs. (151.3±51.8)min, t=7.386, P=0.000］ and higher in-patient cost ［￥(94518.3±15670.7) vs. ￥(81358.4±20228.5), t=6.229, P=0.000］. Other short-term outcomes such as sphincter-preserving rate revealed no significant differences in two groups. There were no differences in 3-year overall survival and disease free survival between two groups. However, in subgroups stratified by TNM staging, robotic group was associated with higher 3-year overall survival (91.3% vs. 67.9%, χ2=3.988, P=0.046)in stage Ⅲ.Conclusion    Compared with laparoscopic surgery, robotic surgical system for rectal cancer is also safe and effective, and has potential advantages in improving short-term outcomes such as the incidence of anastomotic leakage and improving the survival rate of some patients.

Key words: rectal cancer, robotic surgical procedure, laparoscope, postoperative complications, survival outcome