机器人与腹腔镜子宫颈癌根治术的临床比较研究
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摘要
目的:探讨机器人子宫颈癌根治术的安全性、可行性及优势。方法:回顾性分析2016年2月至2017年2月手术治疗的108例ⅠB1～ⅡA2期子宫颈癌患者的临床资料,分析、比较机器人子宫颈癌根治术(RRH组,n=50)与同期腹腔镜子宫颈癌根治术(LRH组,n=58)患者的手术时间、术中出血量、输血率、术后留置尿管时间、术后住院日、术后并发症及近期疗效等情况。结果:RRH组的手术时间短于LRH组(145.2±42.7分钟vs 160.7±28.5分钟)、术中出血量少于LRH组(93.8±42.6 ml vs 127.2±100.1 ml)、输血率低于LRH组(0 vs 12.1%)、术后留置尿管时间短于LRH组(13.9±5.5天vs 16.6±6.6天),差异均有统计学意义(P<0.05)。两组术中切除淋巴结数目、术后肛门排气时间、术后住院日、术后并发症及近期疗效比较,差异均无统计学意义(P>0.05)。结论:机器人子宫颈癌根治术安全可行,且具备手术时间短、术中出血少、输血率低、留置尿管时间短等优势。
Objective: To explore the feasibility,safety and advantages of robotic surgery system in the application of radical hysterectomy.Methods: A retrospective analysis was performed on the clinical data of 108 patients with FIGO stage ⅠB1 ～ ⅡA2 cervical cancer who underwent surgical treatment from February 2016 to February2017.Total 50 cases of robotic radical hysterectomy(RRH group) and 58 cases of laparoscopic radical hysterectomy(LRH group) were involved.The operation duration,estimated blood loss,blood transfusion rate,postoperative urinary tube pull out time,postoperative hospital day,postoperative complications and short-term outcomes were analyzed and compared between the two groups.Results: Compared with the LRH group,the RRH group showed significantly shorter operation time,reduced blood loss,lower rate of blood transfusion,and shorter postoperative urinary tube pull out time(145.2±42.7 min vs 160.7±28.5 min,93.8±42.6 ml vs 127.2±100.1 ml,0 vs 12.1%,13.9±5.5 d vs 16.6±6.6 d,respectively,P<0.05).The number of dissected lymph node,postoperative exhaustion time,postoperative hospital day,postoperative complications and short-term outcomes were similar in the two groups(P >0.05).Conclusions: Robotic radical hysterectomy is feasible and safe,with shorter operation time,less bleeding,lower rate of blood transfusion,and shorter postoperative urinary tube pull out time.
Objective: To explore the feasibility,safety and advantages of robotic surgery system in the application of radical hysterectomy.Methods: A retrospective analysis was performed on the clinical data of 108 patients with FIGO stage ⅠB1 ～ ⅡA2 cervical cancer who underwent surgical treatment from February 2016 to February2017.Total 50 cases of robotic radical hysterectomy(RRH group) and 58 cases of laparoscopic radical hysterectomy(LRH group) were involved.The operation duration,estimated blood loss,blood transfusion rate,postoperative urinary tube pull out time,postoperative hospital day,postoperative complications and short-term outcomes were analyzed and compared between the two groups.Results: Compared with the LRH group,the RRH group showed significantly shorter operation time,reduced blood loss,lower rate of blood transfusion,and shorter postoperative urinary tube pull out time(145.2±42.7 min vs 160.7±28.5 min,93.8±42.6 ml vs 127.2±100.1 ml,0 vs 12.1%,13.9±5.5 d vs 16.6±6.6 d,respectively,P<0.05).The number of dissected lymph node,postoperative exhaustion time,postoperative hospital day,postoperative complications and short-term outcomes were similar in the two groups(P >0.05).Conclusions: Robotic radical hysterectomy is feasible and safe,with shorter operation time,less bleeding,lower rate of blood transfusion,and shorter postoperative urinary tube pull out time.
引文
[1]Goud J,Gottapu K,Vikas MB,et al.Robotic versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for the treatment of early cervical cancer[J].Int J Reprod Contracept Obstet Gynecol,2014,3(1):34-39.
[2]Palep JH.Robotic assisted minimally invasive surgery[J].J Minim Access Surg,2009,5(1):1-7.
[3]Asciutto KC,Kalapotharakos G,L9fgren M,et al.Robot-assisted surgery in cervical cancer patients reduces the time to normal activities of daily living[J].Acta Obstet Gynecol Scand,2015,94(3):260-265.
[4]Mcvey R,Goldenberg M,Bernardini M,et al.Baseline Laparoscopic skill may predict baseline robotic skill and early robotic surgery learning curve[J].J Endourol,2016,30(5):588-592.
[5]Nie JC,Yan AQ,Liu XS.Robotic-assisted radical hysterectomy results in better surgical outcomes compared with the traditional laparoscopic radical hysterectomy for the treatment of cervical cancer[J].Int J Gynecol Cancer,2017,27(9):1990-1999.
[6]王倩青,郭祥翠.宫颈癌根治术中保留盆腔自主神经的临床研究[J].肿瘤学杂志,2016,22(9):768-770.
[7]程晓东,谢幸.妇科恶性肿瘤手术后淋巴回流障碍的预防与处理[J].实用妇产科杂志,2014,30(9):652-653.
[8]Ki EY,Park JS,Lee KH,et al.Incidence and risk factors of lower extremity lymphedema after gynecologic surgery in ovarian cancer[J].Int J Gynecol Cancer,2016,26(7):1327-1332.
[9]Hanprasertpong J,Tungsinmunkong K,Chichareon S,et al.Correlation of p53 and Ki-67(MIB-1)expressions with clinicopathological features and prognosis of early stage cervical squamous cell carcinomas[J].J Obstet Gynaecol Res,2010,36(3):572-580.
[10]Corrado G,Cutillo G,Saltari M,et al.Surgical and oncological outcome of robotic surgery compared with laparoscopic and abdominal surgery in the management of locally advanced cervical cancer after neoadjuvant chemotherapy[J].Int J Gynecol Cancer,2016,26(3):539-546.
[11]Xie Y.Cost-effectiveness of robotic surgery in gynecologic oncology[J].Curr Opin Obstet Gynecol,2015,27(1):73-76.
[2]Palep JH.Robotic assisted minimally invasive surgery[J].J Minim Access Surg,2009,5(1):1-7.
[3]Asciutto KC,Kalapotharakos G,L9fgren M,et al.Robot-assisted surgery in cervical cancer patients reduces the time to normal activities of daily living[J].Acta Obstet Gynecol Scand,2015,94(3):260-265.
[4]Mcvey R,Goldenberg M,Bernardini M,et al.Baseline Laparoscopic skill may predict baseline robotic skill and early robotic surgery learning curve[J].J Endourol,2016,30(5):588-592.
[5]Nie JC,Yan AQ,Liu XS.Robotic-assisted radical hysterectomy results in better surgical outcomes compared with the traditional laparoscopic radical hysterectomy for the treatment of cervical cancer[J].Int J Gynecol Cancer,2017,27(9):1990-1999.
[6]王倩青,郭祥翠.宫颈癌根治术中保留盆腔自主神经的临床研究[J].肿瘤学杂志,2016,22(9):768-770.
[7]程晓东,谢幸.妇科恶性肿瘤手术后淋巴回流障碍的预防与处理[J].实用妇产科杂志,2014,30(9):652-653.
[8]Ki EY,Park JS,Lee KH,et al.Incidence and risk factors of lower extremity lymphedema after gynecologic surgery in ovarian cancer[J].Int J Gynecol Cancer,2016,26(7):1327-1332.
[9]Hanprasertpong J,Tungsinmunkong K,Chichareon S,et al.Correlation of p53 and Ki-67(MIB-1)expressions with clinicopathological features and prognosis of early stage cervical squamous cell carcinomas[J].J Obstet Gynaecol Res,2010,36(3):572-580.
[10]Corrado G,Cutillo G,Saltari M,et al.Surgical and oncological outcome of robotic surgery compared with laparoscopic and abdominal surgery in the management of locally advanced cervical cancer after neoadjuvant chemotherapy[J].Int J Gynecol Cancer,2016,26(3):539-546.
[11]Xie Y.Cost-effectiveness of robotic surgery in gynecologic oncology[J].Curr Opin Obstet Gynecol,2015,27(1):73-76.