检索历史 清除

目的：探讨全机器人系统进行胃癌根治术的安全性和有效性。方法回顾性分析2012年1月至2013年7月间在南京军区南京总医院行机器人胃癌根治术的100例胃癌患者（机器人组）的临床资料，并选取同期行腹腔镜胃癌根治术的100例胃癌患者作为对照（腹腔镜组）。腹腔镜组均采用辅助小切口行体外消化道重建，机器人组则采用体内镜下行消化道重建。结果所有机器人组患者均顺利完成手术，而腹腔镜组有1例因术中出血中转开腹。机器人组较腹腔镜组手术切口短[（4．2±1．7） cm比（8．9±2．6） cm， P＝0．028]，术中出血少[（60±16） ml比（98±17） ml， P＝0．005]，手术时间长[（237±46） min比（188±52） min， P＝0．001]，术后住院时间短[（5．3±2．6） d比（6．1±3．1） d， P＝0．018]，但两组淋巴结清扫数目、肿瘤上下切缘距离、术后排气时间及术后并发症发生率方面的差异均无统计学意义（均P＞0．05）。结论全机器人系统行胃癌根治术安全、有效，较腹腔镜手术短期效果更佳。

Objective To compare the short-term clinical outcomes of laparoscopic and da Vince robotic radical gastrectomy for gastric cancer and evaluate the safety and efficacy of robotic system. Methods Clinical data of 200 consecutive gastric cancer patients undergoing radical gastrectomy , including 100 cases of robotic (RRG group) and 100 cases of laparoscopic (LRG group), in our department from January 2012 to May 2013 were retrospectively analyzed. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in LRG group, and intracorporeal robot-sewn anastomosis in RRG group. Comparative analysis between the two groups for intraoperative factors (conversion, blood loss, operative time, incision length), oncologic outcomes (TMN stage, lymph node dissection, margin) and postoperative parameters (ventilation time, hospital stay, complications, mortality) was performed. Result There was only 1 conversion in LRG group. As compared to LRG group, RRG group was associated with less blood loss [(60±16) vs. (98±17) ml, P=0.005], longer operative time [(215±46) vs. (188±52) min, P=0.001], shorter incision length [(4.2± 1.7) vs. (8.9±2.6) cm, P=0.028], and shorter postoperative hospital stay [(4.5±2.6) vs. (5.7±3.1) d, P=0.018] in RRG group. While there were no significant differences in other aspects between the two groups, such as number of harvested lymph nodes, distance to upper or lower margin of tumor, postoperative bowel function recovery, and postoperative complication morbidity. Conclusion Robotic radical gastrectomy is feasible and safe for gastric cancer , and has better short-term and oncologic outcomes compared with laparoscopic radical gastrectomy.