机器人与腹腔镜辅助右半结肠切除术的疗效分析

Efficacy analysis of robotic versus laparoscopic‑assisted right hemicolectomy

  • 摘要:
    目的 探讨机器人与腹腔镜辅助右半结肠切除术的疗效。
    方法 采用倾向评分匹配及回顾性队列研究方法。收集2020年1月至2023年12月天津医科大学总医院收治的99例右半结肠癌患者的临床病理资料;男50例,女49例;年龄为69(26~89)岁。99例患者中,41例行机器人辅助右半结肠切除术设为机器人组,58例行腹腔镜辅助右半结肠切除术设为腹腔镜组。患者均由同一主刀医师团队行机器人或腹腔镜辅助右半结肠切除术。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较。(2)术中及术后情况。正态分布的计量资料组间比较采用独立样本t检验,偏态分布的计量资料组间比较采用Mann⁃Whitney U检验。计数资料组间比较采用χ²检验或Fisher确切概率法。等级资料组间比较采用非参数秩和检验。倾向评分匹配按1∶1最近邻匹配法进行匹配,卡钳值为0.1。
    结果 (1)倾向评分匹配情况及匹配后两组患者一般资料比较。99例患者中,82例匹配成功,机器人组和腹腔镜组各41例。倾向评分匹配后消除腹部手术史因素混杂偏倚,具有可比性。(2)术中及术后情况。倾向评分匹配后,机器人组患者手术时间为215(130~340)min、术中出血量为50(10~400)mL、淋巴结清扫数目为21(5~55)枚、术后重症监护室入住15例、术后肛门首次排气时间为3(1~12)d、术后首次进食时间为4(2~14)d、术后住院时间为8(5~25)d;腹腔镜组患者上述指标分别为210(140~370)min、50(5~150)mL、19(5~34)枚、20例、3(0~9)d、5(2~10)d、8(6~17)d;两组患者上述指标比较,差异均无统计学意义(Z=-0.94、-1.87、-1.32,χ²=1.25,Z=0.13、-0.83、-0.65,P>0.05)。机器人组和腹腔镜组中转开腹分别为0和1例,两组比较,差异无统计学意义(P>0.05)。两组患者并发症分别为6例和4例,差异无统计学意义(χ²=0.46,P>0.05)。两组患者均为R0切除,无术后30 d再入院。机器人组和腹腔镜组住院费用分别为(11.0±1.8)万元和(9.0±1.7)万元,两组比较,差异有统计学意义(t=-5.27,P<0.05)。
    结论 机器人辅助右半结肠切除术安全性和有效性非劣效于腹腔镜辅助右半结肠切除术,但住院费用更高。

     

    Abstract:
    Objective To investigate the short‑term efficacy of robotic versus laparoscopic-assisted right hemicolectomy.
    Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 99 patients of right colon cancer who were admitted to Tianjin Medical University General Hospital from January 2020 to December 2023 were collected. There were 50 males and 49 females, aged 69(range, 26‒89)years. Of the 99 patients, 41 patients undergoing robotic‑assisted right hemicolectomy were divided into the robotic group, and 58 patients undergoing laparoscopic‑assisted right hemicolectomy were divided into the lapa-roscopic group. Patients received robotic-assisted or laparoscopic-assisted right hemicolectomy operated by the same major surgeon. Observation indicators:(1) propensity score matching status and com-parison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method. The caliper value was set as 0.1.
    Results (1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 99 patients, 82 patients were successfully matched, with 41 cases in each of the robotic group and the laparoscopic group. After propensity score matching, the elimination of history of abdominal operation confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the operation time of the robotic group was 215(range, 130‒340)minutes, the volume of intraoperative blood loss was 50(range, 10‒400)mL, the number of lymph node dissected was 21(range, 5‒55), the number of intensive care unit stay was 15, time to postoperative first flatus was 3(range, 1‒12)days, time to postoperative first food intake was 4(range, 2‒14)days, duration of postoperative hospital stay was 8(range, 5‒25)days. The above indicators of the laparoscopic group were 210(range, 140‒370)minutes, 50(range, 5‒150)mL, 19(range, 5‒34),20, 3(range, 0‒9)days, 5(range, 2‒10)days, 8(range, 6‒17)days, respectively. There was no significant difference in the above indicators between patients of the two groups (Z=‒0.94, ‒1.87, ‒1.32, χ²=1.25, Z=0.13, ‒0.83, ‒0.65, P>0.05). There was no patient converted to open operation in the robotic group, versus 1 patient converted to open operation in the laparoscopic group, showing no significant difference between patients of the two groups (P>0.05). There were 6 cases in the robotic group and 4 cases in the laparoscopic group with complications, showing no significant difference between the two groups (χ²=0.46, P>0.05). Both groups of patients achieved R0 resection and had no readmission 30 days after surgery. The hospital expense was (11.0±1.8)×104 yuan of the robotic group, versus (9.0±1.7)×104 yuan of the laparoscopic group, showing a significant difference between the two groups (t=‒5.27, P<0.05).
    Conclusion Robot‑assisted right hemicolectomy is non inferior to laparoscopic-assisted right hemicolectomy in safety and efficacy, but with higher hospitalization costs.

     

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