机器人与腹腔镜手术治疗妇科疾病围术期效果对比分析

目的通过评价术中和术后结局指标，比较机器人手术和腹腔镜手术治疗妇科疾病的短期预后。 方法回顾性分析甘肃省人民医院2014年2月至2017年10月期间334例实施机器人和腹腔镜手术患者的临床资料，其中机器人手术170例(机器人组)、腹腔镜手术164例(腹腔镜组)。采用t检验、秩和检验、χ²检验、多重线性回归及多元Logistics回归等统计学方法，分析、比较两组的手术评价指标：手术时间、术中出血量、淋巴结清扫数目、术后腹腔引流量、住院时间、术后并发症等。 结果334例患者均顺利完成手术，两组均无大出血、脏器损伤等术中并发症。机器人组无中转开腹，腹腔镜组有4例中转开腹，但差异无统计学意义(P>0.05)。多重线性回归分析显示，机器人组术后腹腔引流量明显少于腹腔镜组(β＝－237.62，95%CI＝－400.11～－75.13，P< 0.05)，手术时间(β＝－7.65，95% CI＝－30.40～－15.10，P< 0.05)和住院时间均短于腹腔镜组(β＝－4.35，95%CI＝－6.69～－2.02，P< 0.001)，淋巴结清扫数目多于腹腔镜组(β＝7.41，95%CI＝5.24～9.57，P< 0.001)，差异均有统计学意义；两组术中出血量(β＝－31.25，95% CI＝－90.68～28.17，P> 0.05)差异无统计学意义。多元Logistic回归分析显示，两组的术后并发症(β＝0.97，95%CI＝0.32～2.95，P> 0.05)差异无统计学意义。 结论机器人手术治疗妇科疾病的围术期效果明显优于腹腔镜手术。

Comparison of robotic surgery and laparoscopy for gynecological tumor in perioperative effect

ObjectiveTo compare the short-term prognosis of robotic surgery and laparoscopy for gynecological tumors through evaluating intra- and post-operative outcomes. MethodsA retrospective analysis was performed on clinical data of 334 patients who underwent robotic surgery and laparoscopy in Gansu Provincial Hospital from Feb. 2014 to Oct. 2017, including 170 cases of robotic surgery (robotic), 164 cases of laparoscopic surgery (laparoscopic). Using t test, Wilcoxon rank-sum tests, χ² test, multivariable linear regression and multivariable logistics regression, analysis and comparison of operation evaluation indexes between two groups: operative time, the estimated blood loss, lymph node yields, postoperative abdominal drainage volume, length of hospital stay, postoperative complications and so on. Results334 patients successfully completed the operation, and no major hemorrhage or other complications occurred in the two groups. There were 0 case and 4 cases convention to laparotomy in the robotic group and laparoscoic group respectively, but the difference was not statistically significant. The multivariable linear regression model showed that postoperative abdominal drainage volume was significantly less in robotic surgery (β=-237.62; 95%CI=-400.11, -75.13; P< 0.05), operative time (β=-7.65; 95%CI=-30.40, -15.10; P< 0.05) and length of hospital stay (β=-4.35; 95%CI=-6.69, -2.02; P< 0.001) were shorter, and lymph node yields were higher (β=7.41; 95%CI=5.24, 9.57; P< 0.001) than laparoscopy. However, no difference was observed between the two surgeries regarding the estimated blood loss (β=-31.25; 95%CI=-90.68, 28.17; P>0.05). The multivariable Logistic regression model showed that postoperative complication between two groups was not statistically significant (β=0.97; 95%CI=0.32, 2.95; P> 0.05). ConclusionsRobotic surgery was more superior to conventional laparoscopy in perioperative effect for gynecologic diseases.