比较机器人、腹腔镜与开腹手术三种手术方式治疗FIGO分期Ⅱ-Ⅲ期卵巢癌初次肿瘤细胞减灭术患者的疗效。

收集2016年1月至2020年12月于解放军总医院第一医学中心妇产科接受卵巢癌初次肿瘤细胞减灭术患者共130例，按照手术方式不同，将患者分为三组，分别为开腹组(87例)、腹腔镜组(23例)与机器人组(20例)，比较三组患者的围手术期参数，手术时间、术中出血量、术中输血率、术中清扫淋巴结总数、术中并发症、术后发热情况及其他术后并发症、术后排气时间、术后病理类型，以及术后随访至2021年12月的疾病复发情况。

三组患者的年龄、体质量指数、内科合并症及既往腹部手术史差异均无统计学意义(P>0.05)，具有可比性，三组患者疾病分期大部分为Ⅲ期。三组患者的手术时间差异无统计学意义(P＝0.328)；术中出血量，机器人组[(231.00±320.20)ml]及腹腔镜组[(241.30±118.37)ml]明显低于开腹组[(823.68±685.73)ml](P<0.001)；术中输血率，机器人组(5.00%)及腹腔镜组(0.00%)明显低于开腹组(48.28%)(P<0.001)；清扫淋巴结总数、术后发热情况及术后并发症三组差异无统计学意义(P>0.05)；术中并发症率，机器人组(5.00%)及腹腔镜组(0.00%)明显低于开腹组(17.24%)(P＝0.046)；术后排气时间，腹腔镜组[(1.87±0.97) d]及机器人组[(2.15±0.81) d]早于开腹组[(3.06±1.09) d](P<0.001)。随访至2021年12月，三组患者术后的无进展生存期差异无统计学意义(P＝0.601)。

对于经过选择的患者，机器人及腹腔镜下行病理分期为Ⅱ-Ⅲ期卵巢癌初次肿瘤细胞减灭手术是安全、可靠的。

To compare the efficacy of robotic, laparoscopic surgery and laparotomy in the treatment of primary cytoreductive surgery for FIGO stage Ⅱ-Ⅲ ovarian cancer.

A total of 130 patients who received primary cytoreductive surgery for ovarian cancer in Department of Gynecology and Obstetrics, The First Medical Center of Chinese PLA General Hospital from Jan. 2016 to Dec. 2020 were collected. According to different surgical methods, they were divided into three groups, including laparotomy group (n= 87), laparoscopy group (n= 23) and robotic group (n= 20). Perioperative parameters (operation time, intraoperative blood loss, intraoperative blood transfusion rate, total number of dissected lymph nodes, intraoperative complications, postoperative fever and other postoperative complications, postoperative exhaust time, postoperative pathological types) were compared among the three groups, as well as disease recurrence during postoperative follow-up until Dec. 2021.

There was no significant difference in age, BMI, medical complications and previous abdominal surgery among the three groups (P> 0.05). No significant difference was found in operating time among the three groups (P= 0.328); The intraoperative blood loss in robotic group and laparoscopic group was significantly lower than that in the laparotomy group [(231.00 ± 320.20)ml and (241.30 ± 118.37)ml vs (823.68 ± 685.73)ml] (P<0.001); and the intraoperative blood transfusion rate in robotic group and laparoscopic group was significantly less than that in laparotomy group (5.00% and 0.00% vs 48.28%, P< 0.001); There was no significant differencein the total number of dissected lymph nodes, postoperative fever and postoperative complications among the three groups (P>0.05); The intraoperative complication rate in robotic group and laparoscopic group was significantly lower than that in laparotomy group (5.00% and 0.00% vs 17.24%, P= 0.046); And the postoperative exhaust time in robotic group and laparoscopic group was earlier than that in laparotomy group [(2.15 ± 0.81) d and (1.87 ± 0.97) d vs (3.06 ± 1.09) d](P< 0.001). The follow-up was lasted to Dec. 2021, and there was no significant difference in postoperative progression-free survival among the three groups (P= 0.601).

Robotic and laparoscopic surgery in primary cytoreductive surgery are safe and reliable for selected patients with FIGO stage Ⅱ-Ⅲ ovarian cancer.