机器人全腔镜-单吻合治疗直肠癌的临床疗效

目的:探讨达芬奇机器人全腔镜-单吻合手术治疗直肠癌的安全与可行性及术后近期疗效。方法:回顾性分析2016年1月—2017年2月在重庆医科大学附属第一医院施行直肠癌手术的124例患者资料,其中有26例行达芬奇机器人手术(机器人组),另98例行传统腹腔镜手术(腹腔镜组),比较两组患者的相关临床指标。结果:两组患者的基本临床资料差异均无统计学意义(均P0.05),具有可比性。与腹腔镜组比较,机器人组手术时间较明显延长(273.5minvs.234.3min),住院总费用明显增加(8.2万元vs.7.2万元),但术中出血量(43.3mLvs.68.4mL),术后排气时间(3.3dvs.4.4d)、进流食时间(3.9dvs.5.4d)、下床时间(4.5dvs.6.8d)、拔除尿管时间(5.0dvs.6.8d)及术后住院时间(10.0dvs.12.3d)均明显缩短(均P0.05)。两组均无中转开腹;两组的远切缘距离、切除淋巴结个数、环周切缘阳性率及术后并发症发生率均无统计学差异(均P0.05)。结论:机器人全腔镜-单吻合用于直肠癌治疗是一项安全且可行的手术方式,具有创伤小、术后恢复快、住院时间短等的优点,但远期疗效需进一步随访。

Clinical efficacy of robotic total endoscopic single anastomosis in treatment of rectal cancer

Objective: To investigate the safety and feasibility as well as short-term efficacy of robotic total endoscopic single anastomosis in treatment of rectal cancer.Methods: The clinical data of 124 rectal cancer patients treated from January 2016 to February 2017 in First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively. Of the patients, 26 cases underwent da Vinci robotic surgery (robotic group) and the other 98 cases underwent traditional laparoscopic surgery (laparoscopic group). The main clinical data between the two groups of patients were compared. Results: The general data of the two groups of patients showed no significant difference (all P>0.05), and were comparable. In robotic group compared with laparoscopic group, the operative time was significantly prolonged (273.5 min vs. 234.3 min) and total hospitalization cost was significantly increased (82 000 yuan vs. 72 000 yuan), but the intraoperative blood loss was significantly reduced (43.3 mL vs. 68.4 mL), and the time to first postoperative gas passage (3.3 d vs. 4.4 d), liquid food intake (3.9 d vs. 5.4 d), ambulation (4.5 d vs. 6.8 d), and urinary tube removal (5.0 d vs. 6.8 d), as well as the length of postoperative hospital stay (10.0 d vs. 12.3 d) were all significantly shortened (all P<0.05). No open conversion was required in either group, and no significant difference was noted in terms of the distance of the distal resection margin, number of resected lymph nodes and the incidence of positive circumferential resection margin and postoperative complications between the two groups (all P>0.05).Conclusion: Robotic total endoscopic single anastomosis in treatment of rectal cancer is a safe and feasible operative technique, with advantages of less trauma, fast postoperative recovery, and short length of hospital stay, but its long-term efficacy still needs follow-up assessment.