不同类型手术机器人全直肠系膜切除术短期疗效的比较

目的：以传统腹腔镜下全直肠系膜切除术（TME）为参照，评估不同手术机器人全直肠系膜切除术的短期疗效。方法：选取2017年1月至2019年5月罹患直肠癌（临床分期在cT1-3NxM0之间）的132例患者，其中，接受达芬奇机器人45例、妙手S机器人43例和腹腔镜44例，比较三组术中清扫淋巴结数量,术中出血量和术后功能恢复等情况。结果：两种不同类型的R-TME之间的疗效没有差异,与L-TME相比，两种R-TME方法的手术时间明显长于L-TME方法（D/M，p=0.045;M/L p=0.043),两种R-TME的清扫的淋巴结数量更多（D/M,,p=0.773, M/L，p=0.033；D/L，p=0.031）,失血量减少（D/M，p=0.732，M/L，p=0.041；D/L，p=0.037),泌尿生殖功能恢复更早（P<0.05),术后严重并发症的发生率低（D/M,P=0.325，D/L，P=0.023；M/L，P=0.031).结论：与传统腹腔镜手术比较，短期疗效内达芬奇或妙手S机器人全直肠系膜切除术中清扫淋巴结数量，术中出血量和术后功能恢复方面表现出相似的优势,且两种机器人之间无显著差异。

Comparison of short-term effects of different types of surgical robots for total mesorectal excision

Objective: To evaluate the short-term efficacy of different surgical robots for total mesorectal excision with traditional laparoscopic mesorectal excision (TME) as a reference. Methods: 132 patients suffering from rectal cancer (cT1-3NxM0 clinical stage)was selected from January 2017 to May 2019. Among them, 45 patients received Da Vinci robot opreation, 43 patients received MicroHand S robot opreation, and 44 patients received laparoscopy opreation, the number of lymph nodes, intraoperative blood loss and postoperative functional recovery was compared in the three groups. Results: There was no difference in the efficacy between the two different types of R-TME. Compared with L-TME, the operation time of the two R-TME methods was significantly longer than that of the L-TME method (D/M, p=0.045; M/ L p=0.043), the number of lymph nodes dissected by the two types of R-TME is more (D/M,, p=0.773, M/L, p=0.033; D/L, p=0.031), blood loss is significantly reduced (D /M, p=0.732, M/L, p=0.041; D/L, p=0.037), the urogenital function recovery are earlier ( P<0.005), and the incidence of serious postoperative complications is lower (D/M ,P=0.325, D/L, P=0.023; M/L, P=0.031). Conclusions: Compared with traditional laparoscopic surgery, the short-term effect of Da Vinci or MicroHand S robot in total mesorectal excision shows similar advantages in terms of the number of lymph nodes, intraoperative blood loss and postoperative functional recovery, and the two robots have similar advantages and no significant difference between them.