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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (06) : 347 -351. doi: 10.3877/cma.j.issn.1674-6899.2018.06.009

所属专题： 机器人手术； 文献；

论著

机器人与腹腔镜手术治疗妇科疾病围术期效果对比分析
王留利1, 闫沛静2, 杨克虎3, 丑赛4, 蔡辉5, 郭天康5, 侯凡6, 陈晓红7, 王海琳6,†()   
  1. 1. 730000　兰州大学第一临床医学院；730000　兰州大学循证医学中心；730000　兰州大学循证医学与临床转化重点实验室；730000　兰州，甘肃省人民医院妇产科
    2. 730000　兰州，甘肃省人民医院临床循证医学研究所
    3. 730000　兰州大学循证医学中心；730000　兰州大学循证医学与临床转化重点实验室；730000　兰州，甘肃省人民医院临床循证医学研究所
    4. 100853　北京，解放军总医院第一医学中心肝胆外二科
    5. 730000　兰州，甘肃省人民医院临床循证医学研究所；730000　兰州，甘肃省人民医院普外科
    6. 730000　兰州大学第一临床医学院；730000　兰州，甘肃省人民医院妇产科
    7. 730000　兰州，甘肃省人民医院妇产科
  • 收稿日期:2018-08-28 出版日期:2018-12-30
  • 通信作者: 王海琳
  • 基金资助:
    甘肃省自然科学基金(18JR3RA052); 甘肃省循证医学与临床转化重点实验室开放基金(GSXZYZH2018006); 甘肃省智慧医疗工程实验室开放基金(GSXZHYL2018001); 兰州市科技局指导性计划(2017-ZD-38)

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

Liuli Wang1, Peijing Yan2, Kehu Yang3, Sai Chou4, Hui Cai5, Tiankang Guo5, Fan Hou6, Xiaohong Chen7, Hailin Wang6,†()   

  1. 1. The First Hospital of Lanzhou University, Lanzhou 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; The Key Laboratory of Evidence-Based Medicine and Clinical Transformation, Lanzhou University, Lanzhou 730000, China; Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Lanzhou 730000, China
    2. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
    3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; The Key Laboratory of Evidence-Based Medicine and Clinical Transformation, Lanzhou University, Lanzhou 730000, China; Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
    4. Department of Heatobiliary and Pancreatic Surgical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    5. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China; Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
    6. The First Hospital of Lanzhou University, Lanzhou 730000, China; Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Lanzhou 730000, China
    7. Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Lanzhou 730000, China
  • Received:2018-08-28 Published:2018-12-30
  • Corresponding author: Hailin Wang
  • About author:
    Corresponding author: Wang Hailin, Email:
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王留利, 闫沛静, 杨克虎, 丑赛, 蔡辉, 郭天康, 侯凡, 陈晓红, 王海琳. 机器人与腹腔镜手术治疗妇科疾病围术期效果对比分析[J/OL]. 中华腔镜外科杂志(电子版), 2018, 11(06): 347-351.

Liuli Wang, Peijing Yan, Kehu Yang, Sai Chou, Hui Cai, Tiankang Guo, Fan Hou, Xiaohong Chen, Hailin Wang. Comparison of robotic surgery and laparoscopy for gynecological tumor in perioperative effect[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(06): 347-351.

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。

关键词: 妇科疾病, 腹腔镜手术, 机器人手术
Objective

To compare the short-term prognosis of robotic surgery and laparoscopy for gynecological tumors through evaluating intra- and post-operative outcomes.

Methods

A 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.

Results

334 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).

Conclusions

Robotic surgery was more superior to conventional laparoscopy in perioperative effect for gynecologic diseases.

Key words: Gynecological disease, Laparoscopy, Robotic surgery
表1 两组妇科疾病患者的一般临床资料比较
组别 例数 年龄(岁，±s) 疾病种类[例(%)]
宫颈癌 子宫内膜癌 卵巢癌 良性疾病
机器人组 170 50.1±10.3 94(55.29) 54(31.76) 3(1.76) 19(11.18)
腹腔镜组 164 49.0±9.1 60(36.58) 56(34.15) 7(4.27) 41(25.00)
P值 ? 0.290 0.001
组别 例数 术前基础合并症[例(%)] 术前病理组织学[例(%)]
高血压 糖尿病 心血管病 贫血 妇科其他疾病 其他系统疾病 鳞状细胞癌 腺癌 其他
机器人组 170 66(19.76) 21(6.29) 8(2.40) 70(20.96) 155(46.41) 95(28.44) 94(28.10) 54(16.20) 22(6.60)
腹腔镜组 164 17(5.09) 10(3.00) 4(1.20) 43(12.87) 116(34.73) 65(19.46) 60(18.00) 56(16.80) 48(14.40)
P值 ? <0.001 0.049 0.266 0.004 <0.001 0.003 ? 0.001 ?
表2 两组妇科疾病患者的手术评价指标比较
组别 例数 手术时间(min, ±s) 术中出血量(ml，±s) 淋巴结清扫(枚，±s) 中转开腹[例(%)] 住院时间(d，±s) 术后腹腔引流量(ml，±s) 术后并发症[例(%)]
机器人组 170 293.81±92.09 216.47±187.00 28.70±10.80 0(0.00) 10.21±4.78 396.25±315.47 10(3.00)
腹腔镜组 164 252.23±108.53 247.87±276.66 17.09±12.50 4(1.20) 12.93±11.23 458.35±781.37 8(2.40)
P值 ? 0.002 0.009 <0.001 0.122 0.001 0.024 0.684
表3 两组妇科疾病患者的术中和术后结局指标的多重线性回归模型
组别 例数 手术时间(min) 术中出血量(ml) 淋巴结清扫(枚) 住院时间(d) 术后腹腔引流量(ml)
机器人组 170 干预组 干预组 干预组 干预组 干预组
腹腔镜组 164 对照组 对照组 对照组 对照组 对照组
β值 ? －7.65 －31.25 7.41 －4.35 －237.62
95%可信区间 ? －30.40～15.10 －90.68～28.17 5.24～9.57 －6.69～－2.02 －400.11～－75.13
P值 ? 0.005 0.366 <0.001 <0.001 0.004
表4 两组妇科疾病患者的术后并发症的多元Logistic回归模型
组别 例数 β值 95%可信区间 P值
机器人组 170 0.97 0.32～2.95 0.792
腹腔镜组 164 对照组 对照组 对照组
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