机器人与腹腔镜下直肠癌根治术的对比研究

发布时间：2018-06-01 03:19

本文选题：直肠癌 + 机器人　；参考：《郑州大学》2017年硕士论文

【摘要】：目的比较机器人与腹腔镜下直肠癌根治术安全性及近期疗效。方法按先后顺序连续选取2014年10月-2016年9月于郑州大学第一附属医院肛肠外科行直肠癌根治手术的患者。其中,达芬奇机器人完成手术69例,腹腔镜完成手术61例。两组患者的性别、年龄、直肠癌的位置、肿瘤直径、病程分期等无统计学差异(P0.05)且具有可比性。比较两组的手术时间、术中出血量、术后首次排气时间、尿管拔出时间、肿瘤远切缘距离、住院天数等安全性及临床疗效指标。结果两组手术均顺利完成,术中无中转开腹。机器人组和腹腔镜组的手术时间分别是(257.49±86.25min vs 214.49±75.76min,P=0.006);机器人组按手术时间先后顺序,前35例手术平均时间为(284.14±98.80)min,后34例手术平均时间为(230.05±61.17)min,且差异具有统计学意义(P=0.022),手术时间随着机器人手术经验积累和手术例数增多而减少;术中出血量少于腹腔镜组(96.52±56.59ml vs 135.74±58.81 ml,P0.05);术后首次排气时间早于腹腔镜组(3.65±1.15 d vs 4.28±1.19 d,P0.05);尿管拔出时间早于腹腔镜组(6.01±1.10 d vs 7.26±1.62d,P0.05);肿瘤下缘距远切缘距离大于腹腔镜组(2.71±1.13 cm vs 2.19±1.30cm,P0.05);平均住院天数少于腹腔镜组(13.68±1.07 d vs 14.16±1.12 d,P0.05)。术后肿瘤远端切缘组织,常规病理显示,均未见癌细胞残留。机器人组与腹腔镜组总体并发症发生率相似(10.14%vs 16.39%),无统计学差异(P=0.292)。结论机器人和腹腔镜都可顺利完成直肠癌微创手术,机器人组手术时间略长于腹腔镜组,但机器人组在术中出血量、术后首次排气时间、尿管拔出时间、肿瘤下缘距远切缘距离、住院天数等方面具有优势。
[Abstract]:Objective to compare the safety and efficacy of radical resection of rectal cancer by robotics and laparoscopy. Methods from October 2014 to September 2016, patients underwent radical rectal cancer surgery in the first affiliated Hospital of Zhengzhou University. Among them, 69 cases were performed by Leonardo da Vinci robot and 61 cases by laparoscopy. There were no significant differences in sex, age, location of rectal cancer, tumor diameter and stage of disease between the two groups (P 0.05). The safety and clinical efficacy indexes of the two groups were compared, such as operation time, intraoperative bleeding volume, first time of exhaust after operation, time of urinary catheter extraction, distance of tumor distant margin, length of stay in hospital, and so on. Results the operation was completed successfully in both groups, and there was no conversion to open operation during the operation. The operation time of robot group and laparoscopic group were 257.49 卤86.25min vs 214.49 卤75.76 min P0. 006 respectively. The average operation time of the first 35 cases was 284.14 卤98.80 min, and that of the latter 34 cases was 230.05 卤61.17 min, and the difference was statistically significant. The intraoperative bleeding was less than that in the laparoscopic group (96.52 卤56.59ml vs 135.74 卤58.81 ml P0.05), the time of the first postoperative venting was earlier than that of the laparoscopic group (3.65 卤1.15 d vs 4.28 卤1.19 d), the time of urinary catheter extraction was earlier than that of the laparoscopic group (6.01 卤1.10 days vs 7.26 卤1.62dP0.05), the distance from the distal margin of the tumor to the distal margin of the laparoscopic group was larger than that of the laparoscopic group (2.71 卤1.13 cm vs 2.19 卤1.30 cm). The average length of hospitalization was less than that of laparoscopy group (13.68 卤1.07 days vs 14.16 卤1.12 days, P 0.05). No residual cancer cells were found in the distal margin of the tumor after operation. The incidence of total complications in the robot group was similar to that in the laparoscopic group (10.14 vs 16.39), and there was no statistical difference between the two groups (P = 0.292). Conclusion both robot and laparoscope can successfully complete the minimally invasive surgery for rectal cancer. The operation time of robot group is a little longer than that of laparoscopy group, but the amount of blood lost during operation, the time of first exhaust after operation, the time of urinary catheter extraction in robot group are much longer than those in the control group. The distance from the lower margin to the distal margin and the length of hospitalization have advantages.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

【相似文献】