切换至 "中华医学电子期刊资源库"
高级检索
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； 文献资源库；

论著 上一篇    下一篇

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 Wang 1, Peijing Yan 2, Kehu Yang 3, Sai Chou 4, Hui Cai 5, Tiankang Guo 5, Fan Hou 6, Xiaohong Chen 7, Hailin Wang 6 , †( )   

  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:
全文 ( ) 下载PDF ( )
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
[1]
Ramirez PT, Adams S, Boggess JF, et al. Robotic-assisted surgery in gynecologic oncology：a society of gynecologic oncology consensus statement: developed by the society of gynecologic oncology clinical practice robotics task force[J]. Gynecologic Oncology, 2012, 124(2)：180-184.
[2]
Aarts JW, Nieboer TE, Johnson N, et al.Surgical approach to hysterectomy for benign gynaecological disease [J]. Cochrane Database Syst Rev, 2015, 12(8): 3677-3677.
[3]
Jacome EG, Hebert AE, Christian F. Comparative analysis of vaginal versus robotic-assisted hysterectomy for benign indications[J]. Journal of Robotic Surgery, 2013, 7(1)：39-46.
[4]
Magrina JF, Zanagnolo V, Noble BN, et al. Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy[J]. Gynecologic Oncology, 2011, 121(1)：100-105.
[5]
Liu Z, Li X, Tian S, et al. Superiority of robotic surgery for cervical cancer in comparison with traditional approaches: a systematic review and meta-analysis[J]. International Journal of Surgery, 2017, 40(2)：145-154.
[6]
Hu LD, Li XF, Wang XY, et al. Robotic versus laparoscopic gastrectomy for gastric carcinoma: a meta-analysis of efficacy and safety[J]. Asian Pacific Journal of Cancer Prevention Apjcp, 2016, 17(9)：4327-4333.
[7]
苟云久，马继龙，姚亮，等. 达芬奇机器人和胸腔镜辅助胸外科手术治疗非小细胞肺癌有效性和安全性的Meta分析[J]．中国循证医学杂志，2017，17(6)：661-668.
[8]
Park DA, Yun JE, Lee SH, et al. Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: a systematic review and meta-analysis[J]. European Journal of Surgical Oncology (EJSO), 2017, 43(6): 994-1002.
[9]
Kilgore JE, Jackson AL, Ko EM, et al. Recurrence-free and 5-year survival following robotic-assisted surgical staging for endometrial carcinoma[J]. Gynecologic Oncology, 2013, 129(1)：49-53.
[10]
Wright JD, Ananth CV, Lewin SN, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease[J]. JAMA, 2013, 309(7)：689-698.
[11]
Kevin WAG, Siebenga J, Belgers EHJ, et al. Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies[J]. European Journal of Cardio-Thoracic Surgery, 2011, 39(4)：575-578.
[12]
Kim JK, Park JS, Hwang HK, et al. Drainage volume after pancreaticoduodenectomy is a warning sign of chyle leakage that inversely correlates with a diagnosis of pancreatic fistula[J]. World Journal of Surgery, 2013, 37(4)：854-862.
[13]
郭芳芳，李冬青，齐金红，等. 机器人手术与腹腔镜宫颈癌根治术的临床比较[J/CD]．中华腔镜外科杂志(电子版)，2016，9(4)：224-227.
[14]
孙小单，袁勇. 机器人及腹腔镜全子宫切除术的临床比较[J/CD]．中华腔镜外科杂志(电子版)，2015，8(2)：18-21.
[15]
Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice[J]. Journal of Minimally Invasive Gynecology, 2008, 15(3)：286-291.
[16]
Li X, Wang T, Yao L, et al. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: a meta-analysis and systematic review[J]. Medicine, 2017, 96(29)：75-85.
[17]
Mäenpää M, Nieminen K, Tomás E, et al. Implementing robotic surgery to gynecologic oncology: the first 300 operations performed at a tertiary hospital[J]. Acta Obstet Gynecol Scand, 2015, 94(5)：482-488.
[18]
Carver BS, Serio A, Eggener SE, et al. The total number of retroperitoneal lymph nodes resected impacts clinical outcome following chemotherapy for metastatic testicular cancer[J]. The Journal of Urology, 2008, 179(4)：175-180.
[19]
Gaia G, Holloway RW, Santoro L, et al. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review[J]. Obstetrics & Gynecology, 2010, 116(6)：1422-1431.
[20]
Maenpaa MM, Nieminen K, Tomas EI, et al, Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial [J]. Am J Obstet Gynecol, 2016, 215(5): 5881-5887.
[1] 倪荔, 张伟英, 汤舟青, 贺昕瑛, 钟宁. 快速康复理念对行腹股沟疝腹腔镜手术患者自我效能的影响[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(06): 665-668.
[2] 曲思娆, 赵曼曼, 李全红, 李芳, 马晶晶, 张义男, 景思然, 孙建丽. 无气腹V-NOTES与传统腹腔镜治疗卵巢囊肿临床疗效比较[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 217-220.
[3] 潘立超, 尹注增, 赵之明. 吲哚菁绿荧光显像在肝胆胰机器人手术中的应用实践与教学[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 149-151.
[4] 刘娟, 肖媛月, 王倩青, 关振堃, 关小明. 盆腔器官脱垂手术新入路：机器人辅助经阴道腹腔镜阴道骶骨固定术[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 168-171.
[5] 金贝贝, 张玉泉, 李季, 高赛楠, 朱春玉, 丁晓颖, 杨晓清. 普通及机器人辅助经脐单孔腹腔镜在子宫肌瘤剔除术中的应用比较[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 163-167.
[6] 赵国栋, 张新宁, 张修平, 赵之明, 高元兴, 刘渠, 王子政, 周志鹏, 刘荣. 分支胰管型导管内乳头状黏液腺瘤外科手术新策略：原位切除联合分支胰管齐根结扎术[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 109-111.
[7] 朱中飞, 何天霖. 达芬奇机器人脾动脉瘤切除重建一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 112-115.
[8] 秦真岳, 王慧慧, 陈继明, 鲍明月, 郑亚峰, 肖惠超, 马洋, 蒋云芬, 施如霞. 单孔腹腔镜手术治疗Ⅲ型(包块型)子宫瘢痕妊娠[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 122-126.
[9] 李成刚, 赵之明, 胡明根, 谭向龙, 张煊, 周志鹏, 姜楠, 贾育泽. 吲哚菁绿在机器人肝脏FNH切除术中的应用[J]. 中华腔镜外科杂志(电子版), 2021, 14(01): 15-18.
[10] 何鹏辉, 刘东宁, 鞠后琼, 仲崇晗, 李太原. 腹部无辅助切口经阴道取标本的全机器人远端胃切除术(GC-NOSES Ⅳ式)[J]. 中华腔镜外科杂志(电子版), 2021, 14(01): 49-52.
[11] 汤庆超, 王锡山. 浅谈应用达芬奇机器人手术平台开展直肠癌NOSES手术的优越性和局限性[J]. 中华结直肠疾病电子杂志, 2021, 10(04): 343-350.
[12] 中国医师协会结直肠肿瘤专业委员会机器人手术专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人结直肠癌手术中国专家共识（2020版）[J]. 中华结直肠疾病电子杂志, 2021, 10(01): 16-25.
[13] 盛祥宗, 黄睿, 王贵玉. 腹腔镜结直肠肿瘤手术术前定位方法的应用现状[J]. 中华结直肠疾病电子杂志, 2021, 10(01): 90-94.
[14] 蓝炘, 朴成林, 安峰铎, 谈明坤, 司振铎, 吴蔚, 赵娜, 冷建军. 3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较[J]. 中华临床医师杂志(电子版), 2021, 15(05): 327-330.
[15] 刘琳, 段树全, 孟宪梅, 党彤. 内镜下逆行阑尾炎治疗术治疗急性非穿孔性阑尾炎疗效对比的Meta分析[J]. 中华胃肠内镜电子杂志, 2021, 08(01): 18-23.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号