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《中华消化外科杂志》2018年9月第17卷第9期论著

达芬奇机器人手术系统辅助与腹腔镜辅助胃肠间质瘤手术的近期疗效分析

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引用本文:
徐子鹏,汪文杰,余稳稳,等.达芬奇机器人手术系统辅助与腹腔镜辅助胃肠间质瘤手术的近期疗效分析[J].中华消化外科杂志,2018,17(9):914-918.DOI:10.3760/cma.j.issn.1673-9752.2018.09.008.
【摘要】

目的:比较达芬奇机器人手术系统辅助与腹腔镜辅助胃肠间质瘤手术的近期临床疗效。
方法:
采用回顾性队列研究方法。收集2016年6月至2018年5月中国人民解放军兰州军区兰州总医院收治的98例胃肠间质瘤患者的临床资料。98例患者中,45例行达芬奇机器人手术系统辅助胃肠间质瘤手术,设为机器人组;53例行腹腔镜辅助胃肠间质瘤手术,设为腹腔镜组。手术由副主任医师以上级别医师施行。肿瘤直径<5 cm的胃间质瘤行楔形切除术。肿瘤直径>5 cm或位于贲门及幽门的胃间质瘤行胃大部切除+消化道重建术(胃空肠吻合术、Brauns吻合术)。肠道间质瘤行肠切除+端侧吻合术。观察指标:(1)手术及术后情况。(2)随访情况。采用门诊和电话方式进行随访,了解肿瘤复发转移情况。随访时间截至2018年7月。符合正态分布的计量资料以±s表示,组间比较采用两独立样本t检验。偏态分布的计量资料以M(范围)表示,组间比较采用非参数检验。计数资料组间比较采用x2检验。
结果:(1)手术及术后情况:98例患者均顺利完成手术。机器人组患者手术时间、术中出血量、术后胃肠功能恢复时间、术后胃肠减压管拔除时间、术后腹腔引流管拔除时间、术后住院时间分别为(152±49)min、100 mL(10~ 300 mL)、(2.6±0.6)d、(1.1±0.3)d、(5.7±1.2)d、(8.3±1.3)d,腹腔镜组分别为(201±62)min、100 mL(5~600 mL)、(3.1±0.7)d、(2.1±1.5)d、(6.9±3.4)d、(11.6±7.0)d,两组患者上述指标比较,差异均有统计学意义(t=-3.983,Z=2.104,t=-3.776,-3.637,-2.018,-2.817,P<0.05)。(2)随访情况:98例患者均获得术后随访,随访时间为2~24个月,中位随访时间为13个月。随访期间,两组患者均未发生肿瘤复发转移。
结论:达芬奇机器人手术系统辅助胃肠间质瘤手术安全有效,与腹腔镜辅助手术比较,其具有手术时间短、术后恢复快、住院时间短等优势。

【Abstract】

Objective:To compare the short-term clinical effects of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST).
Methods:The retrospective cohort study was conducted. The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People′s Liberation Army from June 2016 to May 2018 were collected. Of 98 patients, 45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group. The associate senior and above doctors performed the surgery. The wedge resection was applied to patients with diameter of gastric stromal tumor < 5 cm, and subtotal gastrectomy + digestive tract reconstruction (gastrojejunostomy and Brauns anastomosis)were applied to patients with diameter of gastric stromal tumor > 5 cm or tumor located in the cardia and pylorus. Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018.Measurement data with normal distribution were represented as ±s, and comparison between groups was done using the independentsample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using nonparametric test. Comparisons of count data were analyzed using chisquare test.
Results:(1) Surgical and postoperative situations: 98 patients underwent successful surgery. The operation time, volume of intraoperative blood loss, recovery time of gastrointestinal function, time of gastrointestinal decompression tube removal, time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152±49)minutes, 100 mL (range, 10-300 mL), (2.6±0.6)days, (1.1± 0.3)days, (5.7±1.2)days, (8.3±1.3)days in the robotic group and (201±62)minutes, 100 mL (range, 5- 600 mL), (3.1±0.7)days, (2.1±1.5)days, (6.9±3.4)days, (11.6±7.0)days in the laparoscopic group, with statistically significant difference between groups (t=-3.983, Z=2.104, t=-3.776,-3.637,-2.018, -2.817, P<0.05). (2) follow-up: 98 patients were followed up for 2-24 months, with a median time of 13 months. During the follow-up, there was no tumor recurrence or metastasis between groups.
Conclusion:Compared with laparoscopy-assisted surgery, Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible, with advantages of shorter operation time, faster postoperative recovery and shorter duration of hospital stay.

DOI:10.3760/cma.j.issn.1673-9752.2018.09.008
基金项目:国家科技部、财政部惠民计划(2012GS620101);甘肃省科技重大专项(2011GS04390);甘肃省自然科学基金(1506RJZA309)
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