机器人与腹腔镜胃癌根治术围术期指标比较

Robotic gastrectomy versus laparoscopic gastrectomy in treatment of gastric cancer

  • 摘要: 目的 比较机器人和腹腔镜胃癌根治术的临床疗效。 方法 回顾分析本院普通外二科2012年6月-2017年6月行胃癌根治术515例患者的临床资料,其中男性381例,女性134例,平均年龄59.8岁。按照手术切除方式分为远端胃切除267例、近端胃切除116例和全胃切除132例,比较三种术式中机器人和腹腔镜手术的手术时间、术中失血量、清扫淋巴结数、进食流质饮食时间、术后住院时间及并发症等围术期指标。 结果 在三种术式中,机器人手术均具有术中失血量少远端胃切除:100(50,200) ml vs 100(100,200) ml,P=0.002;近端胃切除:100(80,200) ml vs 130(100,200) ml,P=0.020;全胃切除:150(100,200) ml vs 200(150,325) ml,P=0.001、手术时间长远端胃切除:(222.8±42.9) min vs (189.6±37.1) min,P=0.000;近端胃切除:(222.4±39.4) min vs (195.5±32.4) min,P=0.000;全胃切除:(248.3±41.8) min vs (226.0±47.0) min,P=0.001的特点。术后并发症发生率、进食时间和住院时间与腹腔镜组相当(P均> 0.05)。在远端胃切除中机器人清扫的淋巴结数多于腹腔镜组(25.3±8.7) vs (21.8±8.6),P=0.001,在近端胃切除和全胃切除中,两组均无统计学差异(P> 0.05)。 结论 机器人胃癌根治术与腹腔镜胃癌根治术相比具有术中失血量少、手术时间长的特点。在近端胃切除和全胃切除中,机器人手术清扫淋巴结数与腹腔镜手术相当;但在远端胃切除中,机器人手术较腹腔镜手术清扫淋巴结数多。远端胃切除更适宜采用机器人手术。

     

    Abstract: Objective To compare the surgical outcome of robotic versus laparoscopic gastectomy in treatment of gastric cancer. Methods Clinical data about 515 patients with gastric cancer who underwent robotic gastrectomy (RG) or laparoscopic gastrectomy(LG) in our department from June 2012 to June 2017 were retrospectively analyzed. There were 381 males and 134 females with average age of 59.8 years old. Patients were classified into distal gastrectomy group (DG, n=267), proximal gastrectomy group (PG, n=116) and total gastrectomy group (TG, n=132). The operating time, estimated blood loss, retrieved lymph nodes, time to take liquid diet, postoperative hospital stay and complication were collected and compared in the three groups. Results In the three groups, RG showed less estimated blood lossDG:100 (50, 200) ml vs 100 (100, 200) ml, P=0.002; PG:100 (80, 200) ml vs 130 (100, 200) ml, P=0.020; TG:150 (100, 200) ml vs 200 (150, 325) ml, P=0.001 and longer operating timeDG:(222.8±42.9) min vs (189.6±37.1)min, P=0.000; PG:(222.4±39.4) min vs (195.5±32.4) min, P=0.000; TG:(248.3±41.8) min vs (226.0±47.0) min, P=0.001.There was no significant difference in complication rate, time to take liquid diet and postoperative hospital stay between two groups(all P> 0.05). The lymph nodes achieved by RG were more than that achieved by LG in distal gastrectomy group(25.3±8.7) vs(21.8±8.6), P=0.001. However, it was not significantly different in proximal gastrectomy group and total gastrectomy group (P> 0.05). Conclusion Compared with LG, RG shows less estimated blood loss but longer operating time. The lymph nodes harvested by RG are as many as those harvested by LG in proximal and total gastrectomy group while RG has a advantage of more retrieved lymph nodes in distal gastrectomy compared with LG. RG should be selectively used in distal gastrectomy.

     

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