日间手术模式下国产单孔机器人结直肠癌根治术的安全性及临床疗效

Safety and clinical efficacy of domestic single-port robotic radical resection of colorectal cancer under the ambulatory surgery model

  • 摘要:
    目的 探讨日间手术模式下国产单孔机器人结直肠癌根治术的安全性及临床疗效。
    方法 采用回顾性描述性研究方法。收集2025年3月至2026年1月温州医科大学附属第一医院收治的12例日间手术模式下行国产单孔机器人结直肠癌根治术患者的临床病理资料;男7例,女5例;年龄为(53±9)岁。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。正态分布资料的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。
    结果 (1)手术情况:12例患者均采用经脐单孔机器人手术入路成功完成手术,均于右髂区麦氏点放置1枚12 mm Trocar作为辅助孔及术后引流孔,无中转患者;机器人装机时间为(39±11)min;8例左半结肠癌患者手术时间为204(139~310)min,腹腔内游离时间为130(78~238)min,术中出血量为5.5(2.0~23.0)mL;4例右半结肠癌患者手术时间为270(246~304)min,腹腔内游离时间为199(183~336)min,术中出血量为12.5(3.0~20.0)mL。(2)术后情况:12例患者术后即开始全流质饮食,术后首次肛门排气时间为(2.6±0.5)d,术后首次排便时间为(4.5±1.0)d,右髂区引流管拔除时间为(3.7±1.2)d;术后第1天白细胞计数为(10.6±2.5)×109/L,中性粒细胞百分比为0.83±0.07,血红蛋白为(125±14)g/L。12例患者中,术后2例出现轻度腹痛、腹胀,经对症处理后缓解;均未发生腹腔出血、机械性肠梗阻、吻合口瘘等严重并发症,无围手术期死亡;均在术后24 h内达到出院标准并按日间路径出院。12例患者淋巴结清扫数目为(15±4)枚,3例发生肠周淋巴结转移。12例患者中,术后病理学TNM分期Ⅰ期、Ⅱ期、Ⅲ期分别为6、3、3例,肿瘤分化程度低分化、中分化、高分化腺癌分别为1、6、5例。(3)随访情况:12例患者均获得随访,术后30 d 随访期间,均未出现发热、切口红肿渗脓、腹痛加重等感染相关并发症或需再次入院情况。
    结论 日间手术模式下国产单孔机器人结直肠癌根治术初步探索临床可行。

     

    Abstract:
    Objective To investigate the safety and clinical efficacy of domestic single-port robotic radical resection for colorectal cancer under the ambulatory surgery model.
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent domestic single-port robotic radical resection for colorectal cancer under the ambulatory surgery model at The First Affiliated Hospital of Wenzhou Medical University from March 2025 to January 2026 were collected. There were 7 males and 5 females, aged (53±9) years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were expressed as Mean±SD, and measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers.
    Results (1) Surgical situations: all 12 patients successfully underwent transumbilical single-port robotic surgery, with a 12 mm trocar placed at the McBurney's point in the right iliac region as an auxiliary port and post-operative drainage port. No conversion to open surgery was required. The docking time was (39±11) minutes. For the 8 patients with left-sided colon cancer, the operation time was 204(range, 139-310) minutes, the intraperitoneal dissection time was 130(range, 78-238) minutes, and the volume of intraoperative blood loss was 5.5(range, 2.0-23.0) mL. For the 4 patients with right-sided colon cancer, the operation time was 270(range, 246-304) minutes, the intraperitoneal dissection time was 199(range, 183-336) minutes, and the volume of intraoperative blood loss was 12.5(range, 3.0-20.0) mL.(2) Postoperative situations: a full liquid diet was initiated immediately after surgery in the 12 patients. The time to postoperative first flatus was (2.6±0.5) days, the time to postoperative first defecation was (4.5±1.0) days, and the time to drainage tube removal in the right iliac region was (3.7±1.2) days. On the postoperative first day, the white blood cell count was (10.6±2.5)×10⁹/L, the neutrophil percentage was 0.83±0.07, and the hemoglobin level was (125±14) g/L. Two of the 12 pati-ents experienced mild abdominal pain and distension, which were resolved after symptomatic treatment. No serious complications such as intra-abdominal bleeding, mechanical intestinal obstruction, or anastomotic leakage occurred, and there was no perioperative death. All patients met the discharge criteria within 24 hours postoperatively and were discharged according to the ambulatory pathway. The number of lymph nodes dissected of the 12 patients was 15±4, with pericolic lymph node metastasis observed in 3 cases. Postoperative pathological TNM staging was stage Ⅰ in 6 cases, stage Ⅱ in 3 cases, and stage Ⅲ in 3 cases. There were 1, 6, and 5 cases of poorly differentiated, moderately differentiated, and well differentiated adenocarcinoma, respectively. (3) Follow-up: all the 12 patients received follow-up. During the 30-day follow-up period, none of the 12 patients developed infection-related complications such as fever, incisional erythema with purulent discharge, or aggravated abdominal pain. No readmission was required.
    Conclusion Domestic single-port robotic radical resection for colorectal cancer under the ambulatory surgery model is feasible after preliminary exploration.

     

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