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机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较

李森 薛勇敢 柯沐 黄埔 邝衍绅 孟庆禹 宁伯彬 王文琛 刘唯正 滕志鹏 李鹏 刘洪一 贾宝庆

李森, 薛勇敢, 柯沐, 黄埔, 邝衍绅, 孟庆禹, 宁伯彬, 王文琛, 刘唯正, 滕志鹏, 李鹏, 刘洪一, 贾宝庆. 机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较[J]. 解放军医学院学报, 2023, 44(6): 624-630. doi: 10.3969/j.issn.2095-5227.2023.06.009
引用本文: 李森, 薛勇敢, 柯沐, 黄埔, 邝衍绅, 孟庆禹, 宁伯彬, 王文琛, 刘唯正, 滕志鹏, 李鹏, 刘洪一, 贾宝庆. 机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较[J]. 解放军医学院学报, 2023, 44(6): 624-630. doi: 10.3969/j.issn.2095-5227.2023.06.009
LI Sen, XUE Yonggan, KE Mu, HUANG Pu, KUANG Yanshen, MENG Qingyu, NING Bobin, WANG Wenchen, LIU Weizheng, TENG Zhipeng, LI Peng, LIU Hongyi, JIA Baoqing. Evaluation of short-term outcomes of robotic versus laparoscopic surgery in obese patients with mid-low rectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 624-630. doi: 10.3969/j.issn.2095-5227.2023.06.009
Citation: LI Sen, XUE Yonggan, KE Mu, HUANG Pu, KUANG Yanshen, MENG Qingyu, NING Bobin, WANG Wenchen, LIU Weizheng, TENG Zhipeng, LI Peng, LIU Hongyi, JIA Baoqing. Evaluation of short-term outcomes of robotic versus laparoscopic surgery in obese patients with mid-low rectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 624-630. doi: 10.3969/j.issn.2095-5227.2023.06.009

机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较

doi: 10.3969/j.issn.2095-5227.2023.06.009
详细信息
    作者简介:

    李森,男,硕士,医师。研究方向:胃肠道肿瘤。Email: lisen9427@163.com

    通讯作者:

    贾宝庆,男,博士,主任医师,教授,博士生导师。Email: baoqingjia@126.com

  • 中图分类号: R735.36

Evaluation of short-term outcomes of robotic versus laparoscopic surgery in obese patients with mid-low rectal cancer

More Information
  • 摘要:   背景  由于腹腔镜器械存在自由度低等固有缺点,其在肥胖中低位直肠癌患者中应用受限。而机器人手术相较于腹腔镜在此类人群中应用是否具有优势仍然未知。  目的  比较机器人与腹腔镜手术治疗肥胖中低位直肠癌患者的短期疗效。  方法  回顾性分析2017年2月 - 2022年8月解放军总医院第一医学中心普通外科五病区收治的肥胖中低位直肠癌患者的临床资料,根据手术治疗设备将患者分为机器人组和腹腔镜组,以倾向性评分匹配(propensity score matching,PSM)对两组患者基线资料进行1∶1匹配后比较两组结局指标,评价两种手术方式的短期疗效,应用单因素和多因素logistic回归分析并发症发生的影响因素。  结果  本研究共纳入207例患者,其中机器人组108例,腹腔镜组99例。PSM后两组患者各为66例。机器人组的环周切缘阳性率(4.5% vs 15.2%,P=0.041)及术后30 d内并发症发生率(7.6% vs 22.7%,P=0.015)均低于腹腔镜组,差异有统计学意义。多因素logistic回归分析提示使用机器人手术系统有助于降低术后30 d内并发症发生率(OR:0.269,95% CI:0.090 ~ 0.804,P=0.019)。  结论  与腹腔镜手术相比,机器人手术有助于降低肥胖中低位直肠癌患者术后环周切缘阳性率和术后30 d内并发症发生率,在改善短期疗效方面具有一定优势。

     

  • 表  1  倾向性评分匹配前后两组患者基线资料比较

    Table  1.   Comparison of baseline characteristics of the two groups before and after PSM

     指标倾向性评分匹配前倾向性评分匹配后
    机器人组(n=108)腹腔镜组(n=99)t/Z/χ2P机器人组(n=66)腹腔镜组(n=66)t/Z/χ2P
    年龄/岁58.4 ± 11.260.6 ± 9.61.5230.12960.8 ± 10.560.4 ± 9.1-0.2390.811
     <65岁/(例,%)75(69.4)61(61.6)42(63.6)41(62.1)
     ≥65岁/(例,%)33(30.6)38(38.4)24(36.4)25(37.9)
    性别/(例,%)0.5620.4540.8110.368
     男73(67.6)62(62.6)39(59.1)44(66.7)
     女35(32.4)37(37.4)27(40.9)22(33.3)
    BMI/[kg·m-2Md(IQR)]26.7(25.7,28.2)26.3(25.6,27.7)-1.3390.18126.7(25.7,28.1)26.4(25.6,28.2)-0.0430.965
    ASA/(例,%)1.3150.2520.0001.000
     ≤Ⅱ100(92.6)87(87.9)59(89.4)59(89.4)
     >Ⅱ8(7.4)12(12.1)7(10.6)7(10.6)
    合并症/(例,%)50(46.3)53(53.5)1.0830.29838(57.6)31(47.0)1.4880.223
    既往腹部手术史/(例,%)17(15.7)15(15.2)0.0140.90712(18.2)7(10.6)1.5370.215
    病理分期/(例,%)0.5950.7430.0440.978
     Ⅰ37(34.3)29(29.3)20(30.3)20(30.3)
     Ⅱ32(29.6)31(31.3)20(30.3)21(31.8)
     Ⅲ39(36.1)39(39.4)26(39.4)25(37.9)
    新辅助治疗史/(例,%)34(31.5)8(8.1)17.196<0.0018(12.1)8(12.1)0.0001.000
    肿瘤位置/[cm,Md(IQR)]5.0(4.0,8.0)5.0(4.0,8.0)-0.4530.6515.0(4.0,8.0)5.0(4.0,8.0)-0.3240.746
     0 ~ 5 cm/(例,%)59(54.6)50(50.5)35(53.0)34(51.5)
     >5 ~ 10 cm/(例,%)49(45.4)49(49.5)31(47.0)32(48.5)
    下载: 导出CSV

    表  2  两组患者围术期指标比较

    Table  2.   Comparison of perioperative indicators between the two groups

     指标机器人组
    (n=66)
    腹腔镜组
    (n=66)
    t/Z/χ2P
    手术方式/(例,%)0.0440.833
     直肠前切除术51(77.3)52(78.8)
     经腹会阴联合切除术15(22.7)14(21.2)
    造口/(例,%)36(54.5)34(51.5)0.1220.727
    手术时间/[min,Md(IQR)]165(145,196)155(130,185)-1.5090.131
    中转开腹/(例,%)0(0)0(0)--
    失血量/[mL,Md(IQR)]100(50,100)50(50,100)-1.0970.273
    输血/(例,%)3(4.5)4(6.1)->0.999
    首次进流食时间/[d,Md(IQR)]4(3,4)3(2,3)-1.2510.211
    引流管拔除时间/[d,Md(IQR)]6(5,8)6(5,8)-0.3020.763
    导尿管拔除时间/[d,Md(IQR)]2(1,3)2(1,3)-0.4120.680
    术后住院时间/[d,Md(IQR)]8(7,10)7(6,10)-0.8120.417
    下载: 导出CSV

    表  3  两组患者病理结果比较

    Table  3.   Comparison of pathological outcomes between the two groups

     指标机器人组
    (n=66)
    腹腔镜组
    (n=66)
    t/Z/χ2P
    肿瘤大小/cm3.5 ± 1.33.7 ± 1.20.4910.624
    收获淋巴结数目/[例,Md(IQR)]14(12,16)15(13,17)-1.4890.136
    组织分化程度/(例,%)2.7170.487
     完全缓解2(3.0)1(1.5)
     高1(1.5)0(0)
     中56(84.8)53(80.3)
     低7(10.6)12(18.2)
    脉管侵犯/(例,%)6(9.1)8(12.1)0.3200.572
    神经侵犯/(例,%)4(6.1)6(9.1)0.4330.511
    CRM阳性/(例,%)3(4.5)10(15.2)4.1810.041
    下载: 导出CSV

    表  4  两组患者并发症比较(例,%)

    Table  4.   Comparison of complications between the two groups (n, %)

     指标机器人组
    (n=66)
    腹腔镜组
    (n=66)
    Z/χ2P
    术中并发症1(1.5)1(1.5)-1.000
     输尿管损伤0(0)1(1.5)->0.999 
     急性心血管疾病1(1.5)0(0)->0.999 
    术后并发症5(7.6)15(22.7)5.8930.015
     吻合口瘘0(0)2(3.0)-0.496
     明显失血1(1.5)2(3.0)->0.999 
     肠梗阻0(0)4(6.1)-0.119
     腹腔感染0(0)1(1.5)->0.999 
     肺炎1(1.5)3(4.5)-0.619
     急性脑梗死0(0)1(1.5)->0.999 
     尿潴留1(1.5)0(0)->0.999 
     急性心血管疾病1(1.5)0(0)->0.999 
     急性呼吸衰竭0(0)1(1.5)->0.999 
     输尿管瘘0(0)1(1.5)->0.999 
     乳糜瘘1(1.5)0(0)->0.999 
    Clavien-Dindo分级-0.337
     Ⅱ4(6.1)11(16.7)3.6850.055
     Ⅲ0(0)2(3.0)-0.496
     Ⅳ0(0)2(3.0)-0.496
     Ⅴ1(1.5)0(0)->0.999 
    下载: 导出CSV

    表  5  术后30 d内并发症发生的单因素和多因素logistic回归分析

    Table  5.   Univariate and multivariate logistic regression analysis of factors associated with occurrence of complications within 30 days

     因素单因素分析多因素分析
    OR95% CIPOR95% CIP
    年龄0.831
     ≥65岁 vs <65岁0.8970.332 ~ 2.428
    性别0.476
     男 vs0.6880.246 ~ 1.925
    BMI0.441
     ≥30 kg·m-2 vs 25 ~ <30 kg·m-20.4390.054 ~ 3.575
    合并症0.481
     有 vs0.7090.273 ~ 1.845
    既往腹部手术史0.547
     有 vs0.6210.132 ~ 2.924
    病理分期0.841
     Ⅱ期 vs Ⅰ期1.4410.417 ~ 4.9850.564
     Ⅲ期 vs Ⅰ期1.3020.391 ~ 4.3380.667
    新辅助治疗0.998
     有 vs0.0000.000
    肿瘤位置0.454
     >5 ~ 10 cm vs ≤5 cm0.6910.262 ~ 1.819
    手术路径0.0200.019
     机器人手术 vs 腹腔镜手术0.2790.095 ~ 0.8190.2690.090 ~ 0.804
    手术方式0.817
     经腹会阴联合切除术 vs 直肠前切除术0.8700.267 ~ 2.838
    造口0.436
     有 vs0.6840.263 ~ 1.780
    手术时间0.732
     ≥180 min vs <180 min0.8350.297 ~ 2.345
    失血量0.0780.072
     ≥200 mL vs <200 mL3.2500.876 ~ 12.0523.5250.893 ~ 13.904
    肿瘤大小0.144
     ≥5 cm vs <5 cm0.4470.152 ~ 1.317
    下载: 导出CSV
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  • 收稿日期:  2023-03-24
  • 网络出版日期:  2023-05-05
  • 刊出日期:  2023-06-28

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