目的

比较达芬奇机器人与腹腔镜肝部分切除治疗肝脏肿瘤的围手术期疗效。

方法

回顾性分析2021年1月至2023年6月在广州市第一人民医院肝胆胰脾外科和肝胆外科二科因肝脏肿瘤接受肝部分切除治疗的184例患者的临床资料,其中52例行达芬奇机器人辅助肝部分切除术(机器人组),132例行腹腔镜肝部分切除术(腹腔镜组)。评估机器人组围手术期情况,并通过倾向性匹配,比较两组手术相关指标和术后并发症等。

结果

机器人组手术时长为177(145～243.8)min,在完成20例操作之后,术者可初步度过学习曲线,手术时长逐渐稳定。在完成42例操作后,术者逐步进入熟练期。倾向性匹配后对比机器人组和腹腔镜组,两组的年龄、性别、肿瘤位置等基线资料差异均无统计学意义(P>0.05)。与腹腔镜组相比,机器人组右侧肝部分切除术的手术时间更短(P=0.0002),术中出血量更少(P=0.006)。术后住院时间、术后并发症发生率、术后输血、抗生素使用时长等均无统计学差异(P>0.05)。

结论

采用达芬奇机器人与腹腔镜肝部分切除治疗肝脏肿瘤均安全、有效,其中采用达芬奇机器人肝切除治疗右侧肝脏肿瘤的手术时间更短、出血量更少。

Objective

To compare the perioperative efficacy of da Vinci robot and laparoscopic partial hepatectomy in the treatment of hepatic tumors.

Method

Retrospective analysis was conducted on a cohort of 184 patients with hepatic tumors who underwent partial hepatectomy at the Department of Hepatobiliary Pacreatic Surgery and the Second Department of Hepatobiliary Surgery, Guangzhou First People's Hospital, between Jan. 2021 and Jun. 2023. This cohort comprised two groups: the robot group (n=52) consisting of patients who underwent robotic-assisted partial hepatectomy, and the laparoscope group(n=132) comprising patients who underwent laparoscopic partial hepatectomy. The perioperative status of the robot group was assessed, and a comparison of surgical-related indicators and postoperative complications between the two groups was conducted using propensity score matching.

Results

The average operative time for the robotic surgery group at our center was 177 (145-243.8) minutes. After completing 20 cases,surgeons can begin to navigate the learning curve, with operation time progressively stabilizing. Upon accumulating 42 cases, they can gradually transition into the proficiency phase. After propensity score matching, there were no statistically significant differences in baseline variables such as age, gender, and tumor location between the robotic surgery group and the laparoscopic surgery group (P>0.05). Compared to the laparoscopic surgery group, the robotic surgery group demonstrated significantly shorter operative time for right partial hepatectomy (P=0.0002) and reduced intraoperative blood loss (P=0.006). However,there were no statistically significant differences observed in postoperative hospital stay, postoperative complication rate, postoperative blood transfusion, and duration of antibiotic use (P>0.05).

Conclusion

Laparoscopic and robotic partial hepatectomy with the da Vinci robot are both safe and effective for the treatment of hepatic tumors. Robotic partial hepatectomy for right-sided hepatic tumors has a shorter operation time and less blood loss than laparoscopic partial hepatectomy.