机器人肝切除术与腹腔镜肝切除术的疗效比较

doi:10.16139/j.1007-9610.2018.04.015

摘要/Abstract

摘要： 目的配对比较机器人与传统腹腔镜肝切除的术中及术后结果,评价机器人肝切除术的安全性和优势。方法对我院2010年3月至2017年8月实施的88例微创肝切除术病人的资料进行回顾性分析,按手术方式的不同分为机器人组(n=44)和腹腔镜组(n=44)。采用倾向匹配分析方法,按照1:1的比例,根据病人的性别、年龄、有无肝炎和肝硬化、体质量指数、美国麻醉师协会分级、肝脏切除范围在机器人组病人中进行配对。结果两组病人的术中出血量、术中输血率、术后住院时间、术后并发症发生率和R0切除率无统计学差异。机器人组手术时间较腹腔镜组长[（183.36±64.40） min比（156.25±71.53） min, P=0.013]。但与腹腔镜组相比,机器人组中转开腹率较低（4.5%比22.7%,P=0.013）。结论虽然机器人肝切除手术时间较长,但中转开腹率较低,与传统腹腔镜肝切除术具有相似的安全性。

关键词: 达芬奇机器人, 腹腔镜, 肝切除

Abstract: Objective To perform a matched comparison of surgical and postsurgical outcomes between robotic and laparoscopic liver resections (LLR) and evaluate the advantages of robotic liver resections(RLR). Methods Clinical outcomes among patients undergoing RLR (n=44) and LLR (n=44) in our hospital between March 2010 and August 2017 were reviewed. A 1:1 matched analysis was performed using propensity score matching between patients in RLR group and patients in LLR group based on gender, age, hepatitis, cirrhosis, body mass index, American Society of Anesthesiologists grade and the extent of liver resections. Results Matched patients undergoing robotic and laparoscopic liver resections displayed no significant differences in blood loss, transfusion rate, hospital stay, postsurgical complications and R0 resection rate. RLR was associated with longer operative time, (183.36±64.40) min vs (156.25±71.53) min, P=0.013. The conversion rate in RLR group was lower than in LLR group(4.5% vs 22.7%), P=0.013. Conclusions Lower conversion rate of RLR was observed when compared with LLR in spite of longer operative time. RLR and LLR had similar safety and feasibility.

Key words: Da Vinci robotics system, Laparoscopy, Liver resection

中图分类号:

管若愚, 杨奎, 马迪, 杨宇尘, 陈拥军. 机器人肝切除术与腹腔镜肝切除术的疗效比较[J]. 外科理论与实践, 2018, 23(04): 346-351.

GUAN Ruoyu, YANG Kui, MA Di, YANG Yuchen, CHEN Yongjun. Comparison between robotic liver resection and laparoscopic liver resection[J]. Journal of Surgery Concepts & Practice, 2018, 23(04): 346-351.

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