目的: 比较机器人与腹腔镜直肠癌根治术的术后并发症、术后肛门功能、泌尿功能及生活质量的差异。方法: 收集2021年1月至2022年7月于中南大学湘雅三医院行直肠手术的179例患者临床资料,通过纳入排除标准后,将患者分为机器人组（37例）和腹腔镜组（44例）,进行长达1年时间的随访,比较两组患者术后并发症、肛门功能、泌尿功能和生活质量的差异。结果: 两组患者无中转开腹、无术中死亡病例。术后病理资料、手术情况、围手术期恢复情况,差异无统计学意义,机器人组术后1年并发症总发生率低于腹腔镜组;吻合口瘘、肠梗阻、术后1年再次手术发生率,差异无统计学意义;两组患者症状评分、功能评分和总体健康状况评分术前比较,差异无均统计学意义;术后1月,机器人组的经济困难评分高于腹腔镜组,机器人组的整体恶心呕吐症状评分高于腹腔镜组,术后3月,机器人组较腹腔镜组,疲倦、便秘症状评分、身体功能、总的健康状况,均更具优势;术后6月和术后12月,机器人组患者均有着比腹腔镜组患者更好的总体健康水平;机器人组住院费用高于腹腔镜组。结论: 与腹腔镜手术相比,机器人手术治疗直肠癌在降低术后并发症的发生率和改善患者术后生活质量上具有优势。
Abstract
Objective To compare the differences in postoperative complications, postoperative anal function, urinary function, and quality of life between robotic and laparoscopic radical rectal cancer surgery. Methods The clinical data of 179 patients who underwent rectal surgery in Xiangya Third Hospital of Central South University from January 2021 to July 2022 were collected, and the patients were divided into the robotic group (37 patients) and laparoscopic group (44 patients) through the inclusion and exclusion criteria and were followed up up up for up to one year, comparing the differences in postoperative complications, anal function, urinary function and quality of life of the two groups of patients. Results There were no intermediate openings and no intraoperative deaths in the two groups. Postoperative pathological data, surgical situation, perioperative recovery, the difference was not statistically significant , the total incidence of complications in the robotic group was lower than that of the laparoscopic group at 1 year after surgery ; anastomotic fistula, intestinal obstruction, and the incidence of reoperation at 1 year after surgery, the difference was not statistically significant ; the symptom scores, functional scores, and the overall health scores of the patients of the two groups were higher than that of the laparoscopic group at 1 month after surgery . Comparison, the difference was not statistically significant; 1 month after surgery, the economic hardship score of the robotic group was higher than that of the laparoscopic group , and the overall nausea and vomiting symptom score of the robotic group was higher than that of the laparoscopic group ; 3 months after surgery, the robotic group had a greater advantage over the laparoscopic group in terms of fatigue, constipation symptom scores, physical function, and overall health status; at 6 months postoperatively and 12 months postoperatively, patients in the robotic group had better overall health than patients in the laparoscopic group; and the cost of hospitalisation was higher in the robotic group than in the laparoscopic group. Conclusion Compared with laparoscopic surgery, robotic surgery for rectal cancer has advantages in reducing the incidence of postoperative complications and improving patients' postoperative quality of life.
关键词
直肠癌 /
腹腔镜 /
机器人手术 /
生活质量 /
泌尿功能 /
肛门功能
Key words
rectal cancer /
laparoscopy /
robotic surgery /
quality of life /
urinary function /
anal function
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参考文献
[1] SUNG H, FERLAY J, SIEGEL R L, et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3) : 209-249.
[2] ALLEMANI C, MATSUDA T, DI CARLO V, et al.Global surveillance of trends in cancer survival 2000-14 (CONCORD-3) : analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391(10125) : 1023-1075.
[3] JAYNE D G, THORPE H C, COPELAND J, et al.Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer[J]. Br J Surg, 2010, 97(11) : 1638-1645.
[4] ZHANG Y, FENG H, WANG S, et al.Short- and long-term outcomes of robotic- versus laparoscopic-assisted right hemicolectomy: A propensity score-matched retrospective cohort study[J]. Int J Surg, 2022, 105: 106855.
[5] STEFANIDIS D, WANG F, KORNDORFFER J R, et al.Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload[J]. Surg Endosc, 2010, 24(2): 377-382.
[6] 时明, 李亮, 胡桂, 等. 达芬奇机器人减臂法手术在结直肠癌根治术中的近期临床疗效研究[J]. 湖南师范大学学报 (医学版) , 2022, 19(02) : 28-32.
[7] FLYNN J, LARACH J T, KONG J C H, et al. Patient-Related Functional Outcomes After Robotic-Assisted Rectal Surgery Compared With a Laparoscopic Approach: A Systematic Review and Meta-analysis[J]. Dis Colon Rectum, 2022, 65(10) : 1191-1204.
[8] FENG Q, YUAN W, LI T, et al.Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL) : short-term outcomes of a multicentre randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(11): 991-1004 .
[9] WANG Y, LIU Y, HAN G, et al.The severity of postoperative complications after robotic versus laparoscopic surgery for rectal cancer: A systematic review, meta-analysis and meta-regression[J]. PLoS One, 2020, 15(10) : e0239909.
[10] YAO Q, SUN Q-N, REN J, et al.Comparison of robotic-assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis[J]. J Cancer Res Clin Oncol, 2023, 149(16) : 15207-15217.
[11] LANGENHOFF B S, KRABBE P F, WOBBES T, et al.Quality of life as an outcome measure in surgical oncology[J]. Br J Surg, 2001, 88(5) : 643-652.
[12] DELANEY C P, LYNCH A C, SENAGORE A J, et al.Comparison of robotically performed and traditional laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2003, 46(12) : 1633-1639.
[13] D'ANNIBALE A, MORPURGO E, FISCON V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases[J]. Dis Colon Rectum, 2004, 47(12) : 2162-2168.
[14] CHOI D J, KIM S H, LEE P J M, et al. Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients[J]. Dis Colon Rectum, 2009, 52(11) : 1824-1830.
[15] PARK J S, LEE S M, CHOI G-S, et al.Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial[J]. Ann Surg, 2023, 278(1) : 31-38.
[16] JANCZEWSKI L M, FASKI J, NELSON H, et al.Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer[J]. CA Cancer J Clin, 2023, 73(5): 516-523.
[17] DINDO D, DEMARTINES N, CLAVIEN P-A.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2) : 205-213.
[18] JUUL T, AHLBERG M, BIONDO S, et al.International validation of the low anterior resection syndrome score[J]. Ann Surg, 2014, 259(4) : 728-734.
[19] JORGE J M, WEXNER S D.Etiology and management of fecal incontinence[J]. Dis Colon Rectum, 1993, 36(1) : 77-97.
[20] BADÍA X, GARCÍA-LOSA M, DAL-RÉ R. Ten-language translation and harmonization of the International Prostate Symptom Score: developing a methodology for multinational clinical trials[J]. Eur Urol, 1997, 31(2) : 129-140.
[21] 李一夫, 李晓琳, 张岩, 等. 国际前列腺症状评分的汉化与评价[J]. 全科医学临床与教育, 2019, 17(04) : 305-307.
[22] 丁义江, 丁曙晴, 孙明明, 等. 肛门功能评估在高位复杂性肛瘘治疗中的价值[J]. 临床外科杂志, 2007 (02) : 92-94.
[23] 邵强, 郭宇文, 郭宏波, 等. BPH患者对中文版IPSS理解能力的评估[J]. 中华泌尿外科杂志, 2001 (01) : 46-48.
[24] 万崇华, 孟琼, 张灿珍, 等. 癌症患者生命质量测定量表EORTC QLQ-C30中文版评介[J]. 实用肿瘤杂志, 2005 (04) : 353-355.
[25] 谭诗生, 李杭, 罗健, 等. 欧洲癌症研究与治疗组织研制的生活质量核心调查问卷第3版中文版生活质量调查问卷测评[J]. 中国临床康复, 2006 (04) : 23-27.
[26] 闫晶晶, 牟绍玉, 谭人福, 等. 直肠癌低位前切除综合征评分表中文版的实证研究[J]. 解放军护理杂志, 2015, 32(04) : 12-15.
[27] 冯青阳, 何国栋, 许剑民. 机器人结直肠癌手术中国专家共识 (2020版)[J]. 中华结直肠疾病电子杂志, 2021, 10(01) : 16-27.
[28] 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南 (2018版)[J]. 中华消化外科杂志, 2018, 17(9) : 877-885.
[29] BLOEMEN J G, VISSCHERS R G J, TRUIN W, et al. Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma[J]. Dis Colon Rectum, 2009, 52(7) : 1251-1258.
[30] KIM N-K, KANG J.Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Rob: otic Surgery from an Expert's View[J]. J Korean Soc Coloproctol, 2010, 26(6) : 377-387.
[31] CRIPPA J, GRASS F, DOZOIS E J, et al.Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach: Results From a Large Retrospective Cohort[J]. Ann Surg, 2021, 274(6) : e1218-e1222.
[32] 王春梅, 方方, 李琴, 等. 达芬奇机器人辅助腹腔镜对直肠癌前切除术患者排尿功能及舒适度的影响[J]. 实用临床医药杂志, 2023, 27(20) : 11-15.
[33] VAN KOOTEN R T, ELSKE VAN DEN AKKER-MARLE M, PUTTER H, et al. The Impact of Postoperative Complications on Short- and Long-Term Health-Related Quality of Life After Total Mesorectal Excision for Rectal Cancer[J]. Clin Colorectal Cancer, 2022, 21(4) : 325-338.
[34] 姜文奇, 巴一, 冯继锋, 等. 肿瘤药物治疗相关恶心呕吐防治中国专家共识 (2019年版)[J]. 中国医学前沿杂志 (电子版) , 2019, 11(11): 16-26.
[35] HERRSTEDT J.Antiemetics: an update and the MASCC guidelines applied in clinical practice[J]. Nat Clin Pract Oncol, 2008, 5(1) : 32-43.
[36] HESKETH P J, GRUNBERG S M, HERRSTEDT J, et al.Combined data from two phase III trials of the NK1 antagonist aprepitant plus a 5HT 3 antagonist and a corticosteroid for prevention of chemotherapy-induced nausea and vomiting: effect of gender on treatment response[J]. Support Care Cancer, 2006, 14(4) : 354-360.
[37] MARTINS R S, FATIMI A S, MAHMUD O, et al.Multidimensional Quality of Life After Robotic Versus Laparoscopic Surgery for Rectal Cancer: A Systematic Review and Meta-Analysis[J]. World J Surg, 2023, 47(5) : 1310-1319.
[38] 杜晓辉. 机器人与腹腔镜直肠癌前切除术近期疗效对比研究[J]. 中国实用外科杂志, 2016, 36(11) : 1180-1182.
[39] DEL GUTIÉRREZ DELGADO M P, MERA VELASCO S, TURIÑO LUQUE J D, et al. Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases[J]. J Robot Surg, 2022, 16(1) : 179-187.
[40] TRASTULLI S, FARINELLA E, CIROCCHI R, et al.Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome[J]. Colorectal Dis, 2012, 14(4) : e134-e156.
[41] TEJEDOR P, SAGIAS F, FLASHMAN K, et al.The impact of robotic total mesorectal excision on survival of patients with rectal cancer-a propensity matched analysis[J]. Int J Colorectal Dis, 2019, 34(12) : 2081-2089.
[42] LIU Y, LIU M, LEI Y, et al.Evaluation of effect of robotic versus laparoscopic surgical technology on genitourinary function after total mesorectal excision for rectal cancer[J]. Int J Surg, 2022, 104: 106800.
[43] SIDERIS L, ZENASNI F, VERNEREY D, et al.Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients' characteristics[J]. Dis Colon Rectum, 2005, 48(12) : 2180-2191.
基金
湖南省科技创新计划项目-青年科技人才项目（2022RC1218）
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