正常与超重患者的机器人和腹腔镜胃癌根治对比

目的比较机器人和腹腔镜辅助胃癌根治术在体质量指数正常和超重患者中的临床疗效。 方法回顾分析解放军总医院普通外二科自2012年6月至2017年6月手术的515例胃癌患者的临床资料，其中机器人手术302例、腹腔镜手术213例，按照体质量指数<24 kg/m²和≥24 kg/m²分为体质量指数正常组和超重组，比较正常组和超重组的机器人和腹腔镜手术的围手术期结果。 结果同腹腔镜手术比较，在正常组和超重组中，机器人手术均有手术时间长(219.7 ± 40.3)min vs (190.1 ± 38.5)min、P<0.000，(238.9 ± 44.0)min vs (211.8 ± 43.8)min、P<0.000]和术中出血量少(155.5 ± 198.0)ml vs (196.3 ± 172.6)ml、P<0.000，(166.6 ± 162.0)ml vs (209.4 ± 224.9)ml、P< 0.000]的特点，术后进流食时间、术后住院时间和并发症发生率比较无差异(均P> 0.05)。正常组机器人清扫淋巴结数更多(26.0 ± 9.6)枚vs (21.8 ± 9.5)枚、P<0.000]；超重组机器人和腹腔镜手术比较无统计学差异(22.9 ± 7.2)枚vs (22.3 ± 9.5)枚、P＝0.310]。 结论机器人胃癌根治术在体质量指数正常组和超重组的患者中均安全、有效，同腹腔镜手术相比，机器人手术在正常组的患者中清扫淋巴结数多，或许具有一定优势。

Comparison of robotic gastrectomy and laparoscopic gastrectomy in patients with normal weight and overweight

ObjectiveTo compare the surgical outcome of robotic and laparoscopic radical gastectomy in patients with normal weight and overweight. MethodsFrom Jun. 2012 to Jun. 2017, a total of 515 patients with gastric cancer who underwent robotic gastrectomy (RG, n=302) or laparoscopic gastrectomy (LG, n=213) in our department were retrospectively analysed. Patients were categorized into normal weight(body mass index <24 kg/m²) or overweight (body mass index≥24 kg/m²) group. The perioperative outcomes of RG or LG were compared in the two groups. ResultsIn both normal weight and overweight group, RG shown longer operation time (219.7 ± 40.3)min vs (190.1 ± 38.5)min, P<0.000; (238.9 ± 44.0)min vs (211.8 ± 43.8)min, P<0.000] and less estimated blood loss(155.5 ± 198.0)ml vs (196.3 ± 172.6)ml, P<0.000; (166.6 ± 162.0)ml vs (209.4 ± 224.9)ml, P<0.000] compared with LG, while there was no significant difference in time of eating liquid diet, postoperative stay and complication rate (P> 0.05). There were more retrieved lymph nodes in the normal weight group by RG (26.0 ± 9.6) vs (21.8 ± 9.5), P<0.000]. However, it was not significantly different in the overweight group (22.9 ± 7.2) vs (22.3 ± 9.5), P= 0.310]. ConclusionsRG is safe and effective in both normal weight and overweight group. RG may have the advantage of more retrieved lymph nodes in the normal weight group compared with LG.