梗阻性直肠癌缓解后一期行机器人与腹腔镜根治性切除的疗效分析OA
Efficacy analysis of robotic versus laparoscopic radical resection in one-stage surgery for obstructive rectal cancer after decompression
目的 比较梗阻性直肠癌缓解后一期行机器人与腹腔镜根治手术的临床疗效.方法 回顾性分析2018 年1 月至2022 年12 月行一期根治前切除术的 41 例梗阻性直肠癌患者的临床资料,术前均行支架或导管置入解除梗阻.按手术方式分为机器人组(n=19)和腹腔镜组(n=22),比较两组患者围手术期指标、并发症及短期预后.结果 两组手术均无中转.与腹腔镜组比较,机器人组术中出血量少[20(5,50)mL vs.44(40,52)mL,P=0.012],吻合口加固缝合率高(78.9%vs.27.3%,P=0.001),预防性回肠造口率及术后第1 天 CRP 水平低[5.3%vs.31.8%,P=0.046;(24.1±14.1)mg/L vs.(41.3±21.7)mg/L,P=0.005],术后住院时间短[(10.3±1.7)d vs.(11.4±1.6)d,P=0.040],而手术时间长[(188.4±15.5)min vs.(174.5±9.7)min,P=0.001].两组间左结肠动脉保留、盆底腹膜关闭及环周切缘阳性率、远切缘距离、淋巴结清扫数量,以及术后首次排气时间、拔除尿管时间、肛管留置时间、首次进食流质时间、并发症比较,均无统计学差异(P>0.05).两组患者均获随访,随访时间25～58 个月,中位时间38 个月.两组局部复发率、远处转移率及2 年总生存率比较均无统计学差异(均 P>0.05).结论 机器人手术在梗阻性直肠癌缓解后择期根治术中具有减少出血、降低预防性回肠造口率、缩短住院时间的优势,且不增加并发症风险,但手术时间较长;两种术式短期肿瘤学结局相似.
Objective To compare the efficacy of robotic versus laparoscopic radical resection in one-stage surgery for obstructive rectal cancer after decompression.Methods A retrospective analysis was conducted on the clinical data of 41 patients with obstructive rectal cancer who underwent one-stage radical ante-rior resection at our hospital between January 2018 and December 2022.All patients received preoperative stent or decompression tube placement to relieve the obstruction.They were divided into a robotic group(n=19)and a laparoscopic group(n=22)based on the surgical approach.Perioperative outcomes,complications,and short-term prognosis were compared between the two groups.Results No conversions to open surgery occurred in either group.Compared with the laparoscopic group,the robotic group showed significantly less intraoperative blood loss[20(5,50)mL vs.44(40,52)mL,P=0.012],a higher rate of reinforcement suturing of the anastomosis(78.9%vs.27.3%,P=0.001),a lower rate of protective ileostomy(5.3%vs.31.8%,P=0.046),lower postoperative day 1 CRP levels[(24.1±14.1)mg/L vs.(41.3±21.7)mg/L,P=0.005],and a shorter postoperative hospital stay[(10.3±1.7)d vs.(11.4±1.6)d,P=0.040];however,the total operative time was longer in the robotic group[(188.4±15.5)min vs.(174.5±9.7)min,P=0.001].There were no sig-nificant differences between the two groups in terms of rates of left colonic artery preservation,pelvic peritoneum closure,and positive circumferential resection margin,distal resection margin distance,number of harvested lymph nodes,time to first flatus,catheter removal time,duration of anal tube placement,time to first liquid diet,and complication rates(all P>0.05).All patients were followed up,with a median follow-up time of 38 months(range,25-58 months).No significant differences were observed in local recurrence rates,distant metastasis rates,or 2-year overall survival between the two groups(all P>0.05).Conclusions In elective radical resection for obstructive rectal cancer after decompression,robotic surgery is associated with less blood loss,a lower rate of protective ileostomy,and a shorter hospital stay compared to laparoscopic surgery,without increasing complication risks,albeit with a longer operative time.Short-term oncological outcomes were similar between the two groups.
张云;龚航军;韩刚;曹羽;张言言;张旭;胡建
上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203上海中医药大学附属曙光医院胃肠外科,上海 201203
直肠肿瘤肠梗阻机器人手术腹腔镜手术根治性切除术一期手术
rectal neoplasmsbowel obstructionrobotic surgerylaparoscopyradical resectionone-stage surgery
《中国现代手术学杂志》 2026 (2)
107-113,7
中国医药卫生事业发展基金会医药科研课题项目(chmdf2024-xrzx02-14)
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