机器人与腹腔镜下胰腺肿瘤剜除术疗效与安全性比较
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1.中南大学湘雅三医院 肝胆胰Ⅱ外科,湖南 长沙 410013;2.中国人民武装警察部队湖南省总队医院 外一科,湖南 长沙410006

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李志强,中南大学湘雅三医院主治医师,主要从事胰腺炎和胰腺良性肿瘤方面的研究。

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国家自然科学基金青年基金资助项目(82100688)。


Comparison of efficacy and safety between robotic and laparoscopic pancreatic tumor enucleation
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1.Department of Hepatobiliary and Pancreatic Surgery Ⅱ, the Third Xiangya Hospital, Central South University, Changsha 410013, China;2.Department of Surgery Ⅰ, General Hospital of People's Armed Police Force of Hunan Province, Changsha 410006, China

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    摘要:

    背景与目的 微创外科时代,胰腺肿瘤剜除术(PTE)在胰腺良性肿瘤或低度恶性肿瘤治疗中的作用越来越受到关注,尤其是达芬奇机器人有着视野放大倍数更高、器械操作更灵活等优势,可为PTE的安全实施提供保障,然而,机器人胰腺肿瘤剜除术(RPTE)是否优于腹腔镜胰腺肿瘤剜除术(LPTE)目前尚未定论,因此,本研究就此方面进行探讨。方法 收集中南大学湘雅三医院2020年4月—2024年5月手术治疗的38例良性肿瘤或低度恶性肿瘤患者的临床资料,其中18例行RPTE(RPTE组),20例行LPTE(LPTE组)。比较两组患者的相关临床指标,并进一步对两组中胰头部肿瘤和胰颈体尾部肿瘤患者的临床指标进行亚组比较。结果 全组平均手术时间为125.00 min,平均术中出血量为67.89 mL,无C级胰瘘发生,B级胰瘘、术后出血和再入院发生率分别为39.5%、21.1%和18.4%,术后住院时间平均为11.44 d。整体上,RPTE组手术时间和术中出血量少于LPTE组(均P<0.05)。两组间B级胰瘘、术中出血及再入院发生率和术后住院时间差异均无统计学意义(均P>0.05)。亚组分析结果显示,在胰头部肿瘤患者中,RPTE组手术时间、术中出血量和术后出血发生率均少于LPTE组(均P<0.05),而两组间B级胰瘘发生率、再入院发生率和术后住院时间差异无统计学意义(均P>0.05);在胰颈体尾部肿瘤患者中,RPTE组手术时间、术中出血量均少于LPTE组(均P<0.05),但两组间B级胰瘘发生率、术后出血、再入院发生率和术后住院时间差异无统计学意义(均P>0.05)。结论 微创下PTE治疗胰腺良性肿瘤或低度恶性肿瘤是安全的,与LPTE相比,RPTE可明显缩短手术时间,减少术中出血量,且在减少术后并发症等方面显示出一定优势,尤其是对于胰头部肿瘤患者。然而,本研究的结论尚需更大样本前瞻性研究证实。

    Abstract:

    Background and Aims In the era of minimally invasive surgery, the role of pancreatic tumor enucleation (PTE) in treating benign or low-grade malignant tumors is gaining attention. The Da Vinci robot offers advantages such as enhanced visualization and flexible instrument manipulation, which can ensure the safe implementation of PTE. However, whether robotic pancreatic tumor excision (RPTE) is superior to laparoscopic pancreatic tumor enucleation (LPTE) remains undetermined. Therefore, this study was performed to explore this aspect.Methods The clinical data of 38 patients who underwent surgical treatment for benign or low-grade malignant tumors in the Third Xiangya Hospital of Central South University from April 2020 to May 2024 were collected. Among them, 18 cases underwent RPTE (RPTE group), and 20 cases underwent LPTE (LPTE group). Relevant clinical variables were compared between the two groups, and subgroup comparisons were further conducted for patients with tumors in the head and neck/body/tail of the pancreas.Results The average operative time for the entire group was 125 min, with an average intraoperative blood loss of 67.89 mL, and no C-grade pancreatic fistula occurred. The incidence rates of B-grade pancreatic fistula, postoperative bleeding, and readmission were 39.5%, 21.1%, and 18.4%, respectively, with an average postoperative hospital stay of 11.44 d. Overall, the RPTE group had shorter operative time and less intraoperative blood loss than the LPTE group (both P<0.05). There were no statistically significant differences between the two groups regarding the incidence of B-grade pancreatic fistula, intraoperative bleeding, readmission rate, and postoperative hospital stay (all P>0.05). Subgroup analysis showed that for patients with head tumors, the RPTE group had shorter operative time, less intraoperative blood loss, and a lower incidence of postoperative bleeding than the LPTE group (all P<0.05). However, the differences in the incidence of B-grade pancreatic fistula, readmission rate, and postoperative hospital stay were not statistically significant (all P>0.05). In patients with neck/body/tail tumors, the RPTE group also had shorter operative time and less intraoperative blood loss (both P<0.05), but the differences in incidence of B-grade pancreatic fistula, incidence of postoperative bleeding, readmission rate, and postoperative hospital stay were not statistically significant (all P>0.05).Conclusion Minimally invasive PTE for the treatment of benign or low-grade malignant pancreatic tumors is safe. Compared to LPTE, RPTE can significantly reduce operative time and intraoperative blood loss and shows certain advantages in reducing postoperative complications, particularly for patients with head tumors. However, the conclusion of this study needs to be confirmed by larger prospective studies.

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李志强,孙吉春,涂广平,谢双溪,刘云飞,汪东文,贺舜民,余枭.机器人与腹腔镜下胰腺肿瘤剜除术疗效与安全性比较[J].中国普通外科杂志,2024,33(9):1430-1439.
DOI:10.7659/j. issn.1005-6947.2024.09.010

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  • 收稿日期:2024-07-01
  • 最后修改日期:2024-09-09
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  • 在线发布日期: 2024-10-12