机器人辅助与腹腔镜食管裂孔疝修补联合Nissen胃底折叠术的临床疗效

Clinical efficacy of robot‑assisted versus laparoscopic hiatal hernia repair combined with Nissen fundoplication

    摘要
  • 摘要:
    目的 探讨机器人辅助与腹腔镜食管裂孔疝修补+Nissen胃底折叠术的临床疗效。
    方法 采用回顾性队列研究方法。收集2018年1月至2024年12月新疆维吾尔自治区人民医院收治的281例食管裂孔疝患者的临床资料；男140例,女141例；年龄为（60±11）岁。281例患者中,133例行机器人辅助食管裂孔疝修补+Nissen胃底折叠术,设为机器人组；148例行腹腔镜食管裂孔疝修补+Nissen胃底折叠术,设为腹腔镜组。观察指标：手术时间、食管裂孔横径、术中出血量、术后首次肛门排气时间、术后住院时间、住院总费用、术后 3 个月胃食管反流病问卷评分。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。
    结果 机器人组手术时间、食管裂孔横径、术中出血量、术后首次肛门排气时间、术后住院时间、住院总费用、术后3个月胃食管反流病问卷评分分别为121（120,180）min、2.2（1.5,3.4）cm、20（10,50）mL、24（12,36）h、4（3,6）d、（6.8±1.0）万元、（2.1±1.0）分,腹腔镜组患者上述指标分别为120（120,180）min、2.4（1.6,3.7）cm、30（20,50）mL、36（24,48）h、5（4,7）d、（4.4±0.9）万元、（2.2±1.1）分,两组患者术中出血量、术后首次肛门排气时间、术后住院时间、住院总费用比较,差异均有统计学意义（Z=-5.616、-5.872、-5.590,t=21.050,P<0.05）。两组患者手术时间、食管裂孔横径、术后3个月胃食管反流病问卷评分比较,差异均无统计学意义（Z=-1.218、-1.213,t=0.682,P>0.05）。
    结论 机器人辅助与腹腔镜食管裂孔疝修补+Nissen胃底折叠术均安全、可行；与腹腔镜手术比较,机器人辅助手术可减少术中出血量、加快术后胃肠道功能恢复、缩短术后住院时间,但总体费用较高。

     

    Abstract:
    Objective To investigate the clinical efficacy of robot‑assisted versus laparoscopic hiatal hernia repair combined with Nissen fundoplication.
    Methods The retrospective cohort study was conducted. The clinical data of 281 patients with hiatal hernia who were admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2024 were collected. There were 140 males and 141 females, aged (60±11) years. Among the 281 patients, 133 cases undergoing robot‑assisted hiatal hernia repair combined with Nissen fundoplication were allocated into robotic group and 148 cases undergoing laparoscopic hiatal hernia repair combined with Nissen fundoplication were allocated into laparoscopic group. Observation indicators: operation time, eso-phageal hiatus transverse diameter, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospitalization cost, gastroesophageal reflux disease questionnaire (GERD‑Q) score at postoperative month 3. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test, com-parison 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.
    Results The operation time, esophageal hiatus transverse diameter, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospitaliza-tion cost, GERD‑Q score at postoperative month 3 were 121(120,180) minutes, 2.2(1.5,3.4) cm, 20(10,50) mL, 24(12,36) hours, 4(3,6) days, (6.8±1.0)×104 yuan, 2.1±1.0 for the robotic group, and 120(120,180) minutes, 2.4(1.6,3.7) cm, 30(20,50) mL, 36(24,48) hours, 5(4,7) days, (4.4±0.9)×104 yuan, 2.2±1.1 for the laparoscopic group. There were significant differences in the volume of intraopera-tive blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospita-lization cost between the two groups (Z=-5.616, -5.872, -5.590, t=21.050, P<0.05), while there was no significant difference in operation time, esophageal hiatus transverse diameter, or GERD‑Q score at postoperative month 3 (Z=-1.218, -1.213, t=0.682, P>0.05).
    Conclusions Robot‑assisted and laparoscopic hiatal hernia repair combined with Nissen fundoplication are safe and feasible. Compared to the laparoscopic surgery, robot‑assisted surgery not only reduces volume of intraoperative blood loss and accelerates postoperative recovery of gastrointestinal function, but also shortens postopera-tive hospital stay, although the total hospitalization cost is higher.

     

    • HTML全文
    • 参考文献(23)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回