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

目的达芬奇机器人手术系统在直肠癌根治性切除术中的作用仍不明确。本文总结我科开展达芬奇机器人直肠癌根治手术以来的初步临床经验，对手术的安全性、术后近期疗效和并发症与腹腔镜直肠癌根治手术对比进行分析。 方法2013年11月至2014年8月我科共施行达芬奇机器人根治性直肠癌切除手术33例。选择年龄、性别、体重指数(BMI)、肿瘤部位≤15 cm和术前临床分期大致相同的33例接受腹腔镜直肠癌根治手术的患者进行病例对比研究。 结果达芬奇组较腹腔镜组术中出血量显著减少(89.1±44.5 ml vs 116.7±60.8 ml，P＝0.04)，但手术时间较腹腔镜组延长(168.0±39.0 min vs 148.5±40.2 min，P＝0.05)。两组均无中转开腹病例。达芬奇组术后首次排气时间明显早于腹腔镜组(53.3±15.4 h vs 62.5±11.9 h，P<0.01)，尿管拔除时间亦早于腹腔镜组(3.0±0.9 d vs 4.8±0.9 d，P<0.01)。达芬奇组术后第24小时疼痛指数明显低于腹腔镜组。两组所有患者肿瘤远侧切缘均未查见癌细胞。两组淋巴结清扫数目、肿瘤远切缘距离及术后平均住院日方面均无明显差别。术后平均随访124天(6～302天)，达芬奇组和腹腔镜组各出现一例吻合口瘘，经保守治疗治愈。 结论达芬奇机器人行直肠癌根治性切除术是一项安全有效的新技术，较传统腹腔镜手术具有创伤小、术后疼痛轻、肠功能和排尿功能恢复快的优点。两者对直肠癌手术的长期疗效有待进一步观察。

Comparison of short-term outcomes between robotic-assisted and laparoscopic proctectomy for rectal cancer: a case-control study

ObjectiveThe role of robotic-assisted proctectomy for the treatment of rectal cancer has not been well-defined.This study aimed to compare the short-term outcomes of the first 33 consecutive robotic proctectomy performed in our unit with matched series of laparoscopic proctectomy. MethodsFrom Nov2013 to Sept 2014, 33 cases with rectal cancer(≤15 cm from the anal verge)underwent robotic proctectomy in our institution.Patients treated with laparoscopic proctectomy, matched for age, sex, body mass index, tumor location and TNM staging with those undergoing robotic proctectomy were selected as controls. ResultsThe operating times were longer in the robotic group than in the laparoscopic group(168.0±39.0 vs 148.5±40.2 min, P=0.05). The blood loss was significantly less in the robotic group than that in the laparoscopic group(89.1±44.5 vs 116.7±60.8 ml, P=0.04). The number of retrieved lymph node and the distal resection margin were similar between two groups.The circumferential margin was negative in all the patients.No conversion was necessary in two groups.Compared to the laparoscope, the times to first flatus passage and the times to remove a urinary catheter were significantly shorter in the robotic group(53.3±15.4 vs 62.5±11.9 hrs, 3.0±0.9 vs 4.8±0.9 days, P<0.01). The 24-hour pain scores in the robotic group were significantly less than those in the laparoscopic group.During an average followup of 124 days(range 6-302 days), both groups had one case with anastomotic leakage, which was successfully managed by conservative therapy. ConclusionOur initial experience suggests that a robotic proctectomy is a safe procedure for patients with rectal cancer.The short-term outcomes of the robotic proctectomy are better than those of the laparoscopic proctectomy in terms of blood loss, recovery of bowel and urinary function.The long-term oncologic outcomes need further evaluation.