摘要
目的探讨达芬奇机器人手术系统辅助胃癌根治术的临床疗效.方法采用回顾性队列研究方法.收集2016年6月至2018年6月中国人民解放军联勤保障部队第九四○医院收治的472例行胃癌根治术患者的临床病理资料;男372例,女100例;年龄为(57±11)岁,年龄范围为17~85岁.472例患者术前均行消化道造影、MRI、CT或胃肠镜检查,并经活组织病理学检查明确诊断为胃癌.472例患者中,241例行达芬奇机器人手术系统辅助胃癌根治术设为机器人组;231例行腹腔镜辅助胃癌根治术,设为腹腔镜组.观察指标:(1)手术情况.(2)术后情况.(3)随访和生存情况.采用门诊和电话方式进行随访,了解患者肿瘤复发转移情况和生存情况.随访时间截至2019年1月30日.正态分布的计量资料以Mean±SD表示,组间比较采用t检验.偏态分布的计量资料以M(范围)表示,计数资料以绝对数或百分比表示,组间比较采用χ^2检验.等级资料比较采用秩和检验.采用Kaplan-Meier法计算累积生存率、带瘤生存率、肿瘤复发病死率,Log-rank检验进行生存情况分析.结果472例患者均顺利完成胃癌根治术,均为R0切缘.机器人组行全胃切除+D2淋巴结清扫+Roux-en-Y吻合术,行远端胃大部分切除+D2淋巴结清扫+BillrothⅡ式吻合术,手术时间,上切缘距离,下切缘距离,肿瘤直径,肿瘤浸润深度(浅肌层、深肌层、浆膜下层、浆膜层)分别为107例,134例,(234±44)min,(4±3)cm,(6±4)cm,(5±3)cm,8、17、32、184例;腹腔镜组上述指标分别为94例,137例,(239±46)min,(4±3)cm,(6±4)cm,(5±3)cm,7、19、30、175例,两组比较,差异均无统计学意义(χ^2=0.200,2.459,t=-1.212,-1.074,-0.420,-1.236,Z=0.171,P>0.05).机器人组术中出血量、全胃切除术淋巴结检出数目,远端胃大部分切除术淋巴结检出数目分别为(126±113)mL,(45±14)枚,(36±18)枚;腹腔镜组上述指标分别为(149±132)mL,(39±14)枚,(30±16)枚,两组比较,差异均有统计学意义(t
Objective To explore the clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 472 patients who underwent radical gastrectomy for gastric cancer in the 940 Hospital of the People′s Liberation Joint Service from June 2016 to June 2018 were collected. There were 372 males and 100 females, aged (57±11)years, with a range from 17 to 85 years. Patients underwent gastrointestinal angiography, magnetic resonance imaging, computed tomography or gastrointestinal endoscopy before surgery, and were diagnosed with gastric cancer by biopsy. Of the 472 patients, 241 underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer were allocated into robotic group and 231 underwent laparoscopy-assisted radical gastrectomy were allocated into laparoscopic group. Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect the tumor recurrence and metastasis and survival of patients up to January 30, 2019. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M ( range). Count data were described as absolute number or percentage, and the chi-square test was used for comparison between groups. Comparison of ordinal data was done using the rank-sum test. The accumulative survival rate, tumor-bearing survival rate and mortality of tumor recurrence were calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) Surgical situations: 472 patients underwent successful operation, with R0 margin. Cases with total gastrectomy + D2 lymph node dissection + Roux-en-Y anastomosis, cases with distal subtotal gastrectomy + D2 lymph node dissection + Billroth Ⅱ anastomosis, operation time, upper margin distance, lower m
作者
徐子鹏
汪文杰
熊诗萌
余稳稳
曹廷宝
李坤
于建平
李洪涛
刘宏斌
Xu Zipeng;Wang Wenjie;Xiong Shimeng;Yu Wenwen;Cao Tingbao;Li Kun;Yu Jianping;Li Hongtao;Liu Hongbin(Lanzhou University Second Clinical Medical College,Lanzhou 730000,China;Department of General Surgery,the 940 Hospital of the People′s Liberation Army Joint Service Support Force,Lanzhou 730500,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第5期453-458,共6页
Chinese Journal of Digestive Surgery
基金
国家科技部、财政部惠民计划(2012GS620101)
甘肃省科技重大专项(2011GS04390)
甘肃省自然科学基金(1506RJZA309)
中国博士后科学基金(2015M572710).
关键词
胃肿瘤
胃癌
根治术
疗效
经济性
达芬奇机器人手术系统
腹腔镜检查
Gastric neoplasms
Gastric cancer
Radical gastrectomy
Efficacy
Economy
Da Vinci robotic surgical system
Laparoscopy
