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机器人和开腹手术治疗肝门部胆管癌的对比研究

Robotic hilar cholangiocarcinoma radical resection compared with laparotomy in prognosis

摘要:

目的:比较机器人肝门部胆管癌根治术与传统开腹手术预后的差异。方法:本研究采用单中心、同期、回顾性病例对照研究方法。纳入解放军总医院第一医学中心肝胆外二科2016年1—12月连续收治的47例肝门部胆管癌患者。男性31例,女性16例;年龄(62.3±9.2)岁(范围:40~79岁),体重指数(23.0±2.7)kg/m 2(范围:16.6~28.6 kg/m 2)。根据手术方式不同分为机器人肝门部胆管癌根治术组(简称机器人组, n=16)和开腹肝门部胆管癌根治术组(简称开腹组, n=31)。对患者进行随访,主要结局终点为患者死亡,次要评估终点为肿瘤复发。计量资料采用独立样本 t检验、Mann-Whitney U检验和Kruskal-Wallis检验等进行分析;计数资料采用χ 2检验、Fisher精确检验、一致性检验等进行分析。患者总体生存率采用Kaplan-Meier法进行分析。 结果:机器人组患者的手术时间[(338±71)min]长于开腹组[(256±56)min, t=4.251, P=0.001],机器人组患者的术中出血量少(100 ml比200 ml, Z=121.50, P=0.040)、术后拔除胃管时间早(3 d比4 d, Z=136.0, P=0.011)、术后住院时间短(9 d比12 d, Z=144.50, P=0.040),两组差异均有统计学意义。两组术中输血率、R0切除率,肿瘤最大径的差异均无统计学意义( P值均>0.05)。机器人组和开腹组术后复发率分别为53.3%和67.0%(χ 2=1.04, P=0.307)。机器人组和开腹组的中位生存时间分别为22.0个月和25.0个月,两组总体生存率差异无统计学意义( P>0.05)。 结论:机器人手术治疗肝门部胆管癌的效果不差于传统开腹手术。

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abstracts:

Objective:To compare the long term and short term outcomes between robotic and open surgery for hilar cholangiocarcinoma radical resection.Methods:This is a single-center and retrospective case-control study. Patients underwent hilar cholangiocarcinoma radical resection between January 2016 and December 2016 at Department of Hepatobiliary Surgery of the General Hospital of the Chinese People′s Liberation Army were included. Safety, effectiveness and long-term prognosis of tumors were evaluated. Patients were divided into robotic hilar cholangiocarcinoma radical surgery group (robotic group, n=16) and open hepatic hilar cholangiocarcinoma radical surgery group (open group, n=31) . All cases were confirmed by pathology histological. Age, gender, histology, resection margin status, extent of surgical resection, disease-free survival (DFS) , and overall survival (OS) were retrospectively collected and analyzed.In the follow-up cohort, the primary outcome was patient death and the secondary outcome was tumor recurrence. Continuous variables were expressed as means and medians and were compared using the Student t test if normally distributed or Wilcoxon-Mann-Whitney test for nonparametric variables. Discrete variables were expressed as frequency and percentages and χ 2 or Fisher exact test, when appropriate, were used for comparisons. Kaplan-Meier curves were used to calculate the probability of survival and comparisons were performed using log-rank test. Results:In this study, compared with the open group, the robotic group had a longer operation time ( (338±71) minutes vs. (256±56) minutes, t=4.251, P=0.001) , but the intraoperative blood loss was less (100 ml vs. 200 ml, Z=121.50, P=0.040) , the gastric tube removal time was earlier (3 days vs. 4 days, Z=136.0, P=0.011) , and the postoperative hospital stay was shorter (9 days vs. 12 days, Z=144.50, P=0.040) , and the difference was statistically significant.There was no significant difference in the blood transfusion rate, R0 resection rate, and tumor size between the two groups.The recurrence rates in the robotic group and open surgery were 53.3% and 67.0%, respectively (χ 2=1.04, P=0.307) .The median survival time of the robotic group and the open group was 22.0 months and 25.0 months. There was no significant difference in the overall survival rate between the two groups ( P>0.05) . Conclusion:Compared with laparotomy, robotic HCC radical resection could have an equivalence or non-inferiority approach with acceptable long-term outcome.

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作者: 丑赛 [1] 常正尧 [1] 赵国栋 [1] 宋栋达 [1] 张煊 [1] 胡明根 [1] 刘荣 [1]
第一作者: 丑赛
期刊: 《中华外科杂志》2020年58卷3期 230-234页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2020.03.012
发布时间: 2021-09-26
基金项目:
国家重点研发计划 National Key Research and Development Program of China
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