机器人和腹腔镜治疗中低位直肠癌对照研究
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摘要
目的对比机器人和腹腔镜治疗中低位直肠癌的近期疗效。方法自2017年3月18日至2017年10月25日,共有56例中低位直肠癌患者在解放军总医院普通外二科接受直肠癌根治术,患者被随机分组接受机器人或腹腔镜手术,对两组的临床资料进行了比较。结果最终机器人组27例,腹腔镜组29例。机器人组较腹腔镜组在手术时间、术后镇痛时间、排气时间、恢复饮食时间、导尿管留置时间、住院日和淋巴结清扫数目方面差异均无统计学意义(均P> 0.05)。机器人组术中失血量比腹腔镜少[(77.0±50.0)mL vs.(121.0±129.8)mL],但差异无统计学意义(Z=-1.825,P=0.068)。机器人组术后有1例吻合口漏和1例肠梗阻,腹腔镜组术后有1例吻合口出血和1例肺部感染,术后并发症发生率方面差异无统计学意义(7.4%vs. 6.9%,χ~2=0.006,P=1.000)。结论机器人和腹腔镜直肠癌根治术围术期效果相当,远期功能学和肿瘤学效果有待进一步随访。
Objective To compare the surgical outcome of robotic and laparoscopic total mesorectal excision in patients with mid and low rectal cancer. Methods From March 18, 2012 to October 25, 2017, a total of fifty-six patients with mid and low rectal cancer underwent total mesorectal excision in our department. Patients were randomized to robotic or laparoscopic group. The perioperative outcomes of robotic total mesorectal excision(RTME) and laparoscopic total mesorectal excision(LTME) were compared. Results Twenty-seven patients underwent RTME and twenty-nine underwent LTME. There were no differences in operation time, postoperative analgesic time, time to first flatus, time of first diet, time to remove the urinary catheter, length of stay and number of retrieval lymph node(P > 0.05). The estimated blood loss seemed less in the RTME group, however it was not statistically different [(77.0±50.0) mL vs.(121.0±129.8) mL, Z=-1.825, P=0.068]. One anastomotic leakage and one ileus occurred in the RTME group while one anastomotic bleeding and one pneumonia happened in the LTME group. There was no difference in postoperative complication rate [7.4%(2/27) vs. 6.9%(2/29), χ~2=0.006, P=1.000].Conclusion The perioperative outcome was similar between RTME and LTME. The long-term functional and oncologic outcome needs further follow-up.
Objective To compare the surgical outcome of robotic and laparoscopic total mesorectal excision in patients with mid and low rectal cancer. Methods From March 18, 2012 to October 25, 2017, a total of fifty-six patients with mid and low rectal cancer underwent total mesorectal excision in our department. Patients were randomized to robotic or laparoscopic group. The perioperative outcomes of robotic total mesorectal excision(RTME) and laparoscopic total mesorectal excision(LTME) were compared. Results Twenty-seven patients underwent RTME and twenty-nine underwent LTME. There were no differences in operation time, postoperative analgesic time, time to first flatus, time of first diet, time to remove the urinary catheter, length of stay and number of retrieval lymph node(P > 0.05). The estimated blood loss seemed less in the RTME group, however it was not statistically different [(77.0±50.0) mL vs.(121.0±129.8) mL, Z=-1.825, P=0.068]. One anastomotic leakage and one ileus occurred in the RTME group while one anastomotic bleeding and one pneumonia happened in the LTME group. There was no difference in postoperative complication rate [7.4%(2/27) vs. 6.9%(2/29), χ~2=0.006, P=1.000].Conclusion The perioperative outcome was similar between RTME and LTME. The long-term functional and oncologic outcome needs further follow-up.
引文
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[4]Weber PA,Merola S,Wasielewski A,et al.Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J].Dis Colon Rectum,2002,45(12):1689-1694;discussion 1695-1686.
[5]杜晓辉.应用达芬奇机器人手术系统治疗低位直肠癌[J].中华消化外科杂志,2010,2(9):116-118.
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[10]D′Annibale A,Pernazza G,Monsellato I,et al.Total mesorectal excision:A comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer[J].Surgical endoscopy,2013,27(6):1887-1895.
[11]Park SY,Choi GS,Park JS,et al.Urinary and erectile function in men after total mesorectal excision by laparoscopic or robotassisted methods for the treatment of rectal cancer:A case-matched comparison[J].World J Surg,2014,38(7):1834-1842.
[12]Park EJ,Cho MS,Baek SJ,et al.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer:A comparative study with laparoscopic surgery[J].Ann Surg,2015,261(1):129-137.
[13]Kim J,Baek SJ,Kang DW,et al.Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection:Long-term survival analysis using propensity score matching[J].Dis Colon Rectum,2017,60(3):266-273.
[14]王勉,李前进,郑建勇,等.达芬奇机器人与腹腔镜手术在直肠癌根治术中的病例对比研究[J/CD].中华结直肠疾病电子杂志,2015,4(1):40-44.
[15]张海容,袁维堂,周全博,等.机器人与腹腔镜在中下段直肠癌根治术中的应用效果比较[J].中华胃肠外科杂志,2017,20(5):540-544.
[16]李鹏,李冰,刘洪一,等.达芬奇机器人手术系统在胃癌中的应用[J].临床与病理杂志,2015,(6):1103-1106.
[17]杜晓辉,邹振玉,李荣.机器人与3d腹腔镜辅助直肠癌根治术近期疗效对比研究[J].腹部外科,2016,29(3):205-208.
[18]雷伟琦,张东,刘莱蓬,等.机器人与腹腔镜直肠癌全系膜切除术近期疗效对比的meta分析[J].实用医学杂志,2016,32(17):2903-2907.
[2]NCCN Clinical Practice Guidelines in Oncology:rectal canccer[OL].National Comprehensive Cancer Network,2017,Version 3(REC-B):1.
[3]Kayano H,Okuda J,Tanaka K,et al.Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer[J].Surgical Endoscopy,2011,25(9):2972-2979.
[4]Weber PA,Merola S,Wasielewski A,et al.Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J].Dis Colon Rectum,2002,45(12):1689-1694;discussion 1695-1686.
[5]杜晓辉.应用达芬奇机器人手术系统治疗低位直肠癌[J].中华消化外科杂志,2010,2(9):116-118.
[6]Hanly EJ,Talamini MA.Robotic abdominal surgery[J].Am J Surgery,2004,188(4A Suppl):19s-26s.
[7]Yamaguchi T,Kinugasa Y,Shiomi A,et al.Learning curve for robotic-assisted surgery for rectal cancer:Use of the cumulative sum method[J].Surgical Endoscopy,2015,29(7):1679-1685.
[8]Foo CC,Law WL.The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon[J].World J Surg,2016,40(2):456-462.
[9]Speicher PJ,Englum BR,Ganapathi AM,et al.Robotic low anterior resection for rectal cancer:A national perspective on short-term oncologic outcomes[J].Ann Surg,2015,262(6):1040-1045.
[10]D′Annibale A,Pernazza G,Monsellato I,et al.Total mesorectal excision:A comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer[J].Surgical endoscopy,2013,27(6):1887-1895.
[11]Park SY,Choi GS,Park JS,et al.Urinary and erectile function in men after total mesorectal excision by laparoscopic or robotassisted methods for the treatment of rectal cancer:A case-matched comparison[J].World J Surg,2014,38(7):1834-1842.
[12]Park EJ,Cho MS,Baek SJ,et al.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer:A comparative study with laparoscopic surgery[J].Ann Surg,2015,261(1):129-137.
[13]Kim J,Baek SJ,Kang DW,et al.Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection:Long-term survival analysis using propensity score matching[J].Dis Colon Rectum,2017,60(3):266-273.
[14]王勉,李前进,郑建勇,等.达芬奇机器人与腹腔镜手术在直肠癌根治术中的病例对比研究[J/CD].中华结直肠疾病电子杂志,2015,4(1):40-44.
[15]张海容,袁维堂,周全博,等.机器人与腹腔镜在中下段直肠癌根治术中的应用效果比较[J].中华胃肠外科杂志,2017,20(5):540-544.
[16]李鹏,李冰,刘洪一,等.达芬奇机器人手术系统在胃癌中的应用[J].临床与病理杂志,2015,(6):1103-1106.
[17]杜晓辉,邹振玉,李荣.机器人与3d腹腔镜辅助直肠癌根治术近期疗效对比研究[J].腹部外科,2016,29(3):205-208.
[18]雷伟琦,张东,刘莱蓬,等.机器人与腹腔镜直肠癌全系膜切除术近期疗效对比的meta分析[J].实用医学杂志,2016,32(17):2903-2907.