机器人与腹腔镜辅助右半结肠全系膜切除术治疗右半结肠癌短中期疗效单中心、单外科医生经验
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作者单位:

1.西南医科大学附属医院 普通外科,四川 泸州 646000;2.中国人民解放军陆军特色医学中心(大坪医院) 普通外科,重庆 400042

作者简介:

黄彬,西南医科大学附属医院副主任医师,主要从事结直肠肿瘤微创治疗方面的研究。

基金项目:

国家重点研发计划基金资助项目(2017YFC0908200);中国人民解放军陆军特色医学中心人才创新能力培养计划基金资助项目(2019CXLCB004)。


Short- to mid-term efficacy of robot-assisted versus laparoscopic-assisted right hemicolectomy with complete mesocolic excision for right-sided colon cancer: a single-center and single-surgeon experience
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Affiliation:

1.Department of General Surgery, the Affiliated Hospital of Southwest Medical Uniwersity, Luzhou 646000, China;2.Department of General Surgery, Army Medical Center of PLA (Daping Hospita), Chongqing 400042, China

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    摘要:

    背景与目的 在过去的10年里,结肠全系膜切除术(CME)的理念得到了进一步的发展,以期望尽量减少右半结肠癌的复发,机器人技术能够克服腹腔镜手术的局限性,但其是否有明确的优势仍存在争议。因此,本研究进一步比较机器人和腹腔镜右半结肠切除术联合CME治疗右半结肠癌的疗效。方法 回顾性分析2016年7月—2021年12月中国人民解放军陆军特色医学中心收治的169例行右半结肠CME治疗的右半结肠癌患者临床资料。手术均由一名外科医生完成,其中,61例行达芬奇机器人辅助右半结肠CME(机器人组);108例行腹腔镜辅助右半结肠CME(腹腔镜组)。比较两组患者相关临床指标。结果 两组术前一般资料差异均无统计学意义(均P>0.05)。两组患者均无围手术期死亡病例。机器人组的手术中转开腹率明显低于腹腔镜组(0 vs. 6.5%,P=0.042),腹腔镜中转的主要原因为严重的腹腔粘连(4例)与肿瘤巨大影响手术视野及操作(3例)。机器人组总手术时间明显长于腹腔镜组(221.1 min vs. 186.0 min,P<0.001)、总住院费用明显高于腹腔镜组(90 371.5元vs. 65 136.3元,P<0.001)。两组的术中出血量、术后首次经口进食时间、术后肛门排气时间、术后住院时间、围手术期并发症发生率、术后病理结果方面差异均无统计学意义(均P>0.05)。全组患者术后中位随访时间31(1~65)个月,机器人组与腹腔镜组无病生存率(82.6% vs. 82.8%,P=0.722)、总生存率(87.9% vs. 84.3%,P=0.870)差异均无统计学意义。结论 机器人辅助右半结肠CME是一种安全可行的手术方式;与传统腹腔镜手术相比,尽管手术耗时较长、费用较高,但在处理腹腔严重粘连及体积巨大肿瘤时可能具有一定优势。

    Abstract:

    Background and Aims In the past decade, the concept of complete mesocolic excision (CME) has been further developed in attempt to minimize the recurrence of right-sided colon cancer. Robotic technology can overcome the limitations of laparoscopic surgery, but its clear advantages are still controversial. Therefore, this study further compares the efficacy of robotic and laparoscopic right hemicolectomy with CME for the treatment of right-sided colon cancer.Methods Clinical data of 169 patients with right-sided colon cancer who underwent right hemicolectomy with CME at the Army Medical Center of PLA from July 2016 to December 2021 were retrospectively analyzed. All operations were performed by one surgeon. Among them, 61 cases underwent Da Vinci robotic-assisted right hemicolectomy with CME (robotic group), and 108 cases underwent laparoscopic-assisted right hemicolectomy with CME (laparoscopic group). The main clinical variables of the two groups of patients were compared.Results There was no statistically significant difference in the general preoperative data between the two groups (all P>0.05). There were no cases of perioperative death in either group. The conversion rate during surgery in the robotic group was significantly lower than that in the laparoscopic group (0 vs. 6.5%, P=0.042). The main reasons for conversion in the laparoscopic group were severe abdominal adhesions (4 cases) and large tumors that affected surgical visibility and operation (3 cases). The total operative time in the robotic group was significantly longer than that in the laparoscopic group (221.1 min vs. 186.0 min, P<0.001), and the total treatment cost was significantly higher in the robotic group than in the laparoscopic group (90 371.5 yuan vs. 65 136.3 yuan, P<0.001). There was no statistically significant difference between the two groups in terms of intraoperative blood loss, time to oral intake, time to anal gas passage, length of postoperative hospital stay, incidence of perioperative complications, and postoperative pathological results (all P>0.05). The median follow-up time for the whole group of patients was 31 (1-65) months. There was no statistically significant difference in disease-free survival rate (82.6% vs. 82.8%, P=0.722) or overall survival rate (87.9% vs. 84.3%, P=0.870) between the robotic and laparoscopic groups.Conclusion Robotic-assisted right hemicolectomy with CME is a safe and feasible surgical approach. Compared with traditional laparoscopic surgery, although it may take longer and be more expensive, it may have some advantages in managing severe abdominal adhesions and large tumors.

    表 2 机器人组与腹腔镜组患者围手术期情况Table 2 The perioperative conditions of patients in the robotic and laparoscopic groups
    表 1 机器人组与腹腔镜组患者一般资料Table 1 General information of patients in the robotic and laparoscopic groups
    图1 机器人组与腹腔镜患者术后生存曲线 A:无病生存率;B:总生存率Fig.1 Postoperative survival curves of patients in the robotic and laparoscopic groups A: Disease-free survival rate; B: Overall survival rate
    表 3 机器人组与腹腔镜患者术后病理结果Table 3 Postoperative pathological results of patients in the robotic and laparoscopic groups
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黄彬,田跃,郑辉超,童卫东,姚晖.机器人与腹腔镜辅助右半结肠全系膜切除术治疗右半结肠癌短中期疗效单中心、单外科医生经验[J].中国普通外科杂志,2023,32(4):497-505.
DOI:10.7659/j. issn.1005-6947.2023.04.003

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  • 收稿日期:2023-01-03
  • 最后修改日期:2023-03-20
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  • 在线发布日期: 2023-04-28