摘要
目的:比较达芬奇机器人与腹腔镜下中低位直肠癌行全直肠系膜切除术的排便与泌尿生殖功能。方法:采用前瞻性对照研究的方法分析2020年6月至2022年10月期间贵州省人民医院胃肠外科行直肠癌前切除的120例中低位直肠癌患者的临床资料,其中腹腔镜手术组65例,机器人手术组55例。所有患者均经结肠镜及盆腔核磁共振检查定位,肿瘤下缘距离肛缘≤10 cm。收集患者的临床资料,并于术后12个月时通过问卷随访,采用Wexner评分和低位前切除综合征量表(LARS)评估肛门排便功能;分别以国际前列腺症状评分(IPSS)和国际尿失禁咨询委员会下尿路症状量表(ICIQ-MLUTS/ICIQ-FLUTS)评估泌尿功能;男性功能采用国际勃起功能指数(IIEF-5评分)、女性采用性功能指数(FIFS-19)评估生殖功能。结果:机器人手术组术后肛门排便功能优于腹腔镜手术组[LARS评分(4.3±2.2)比(9.8±1.5),t=9.151,P=0.038];机器人手术组和腹腔镜手术组患者均未出现严重的泌尿功能障碍,机器人手术组在男性泌尿功能保护上有一定的优势[ICIQ-MLUTS(1.8±5.8)比(13.8±4.9),t=4.128,P=0.038],而两组女性的泌尿功能差异无统计学意义[ICIQ-FLUTS(-0.3±1.0)比(-0.2±0.9),t=0.015,P=0.844)]。机器人手术组和腹腔镜手术组在生殖功能方面差异无统计学意义[IIEF-5评分(-13.4±2.7)比(-11.7±3.4),t=0.35,P=0.615;FIFS-19(-5.2±4.6)比(-10.5±6.4),t=4.128,P=0.254]。结论:机器人较腹腔镜手术对于中低位直肠癌术后有更好的肛门排便可能,在男性泌尿功能保护上有一定的优势,在男性、女性生殖功能保护方面两种手术方式作用相当。
Objective To compare the postoperative anorectal and urogenital function in patients undergoing Da Vinci robot vs laparoscopic total mesorectal excision(TME)for middle and low rectal cancer.Methods A prospective controlled study was conducted to analyze the clinical data of 120 patients with middle and low rectal cancer receiving low anterior resection(Dixon procedure)at the Department of Gastrointestinal Surgery,Guizhou Provincial People's Hospital from Jun 2020 to Oct 2022,including 65 patients in the laparoscopic surgery group and 55 patients in the robotic surgery group.All patients underwent colonoscopy and pelvic MRI,and the distance of the tumor from the anal margin was less than 10 cm.The clinical data of the patients were collected and followed up by questionnaire at 12 months after operation.The anal defecation function was assessed by Wexner constipation score and low anterior resection syndrome scale(LARS).The urinary function was measured by International Prostate Symptom Score(IPSS)and International Advisory Committee on Urinary Incontinence Lower Urinary Tract Symptom Scale(ICIQ-MLUTS/ICIQ-FluTS).Reproductive function was valued by International Index of Erectile Function(IIEF-5 score)was used for male function and the sexual function index(FIFS-19)for females.Results The postoperative anal defecation function in robotic group was better than that of the laparoscopic group,and the LARS score was(4.3±2.2)vs.(9.8±1.5),t=9.151,P=0.038.There was no serious urinary dysfunction in neither groups.The robot group had a certain advantage in the protection of male urinary function[ICIQ-MLUTS,(1.8±5.8)vs.(13.8±4.9),t=4.128,P=0.038],while there was no significant difference in the female urinary function between the two groups.ICIQ-FLUTS[(-0.3±1.0)vs.(-0.2±0.9),t=0.015,P=0.844].There was no significant difference in reproductive function between the two groups,IIEF-5 score[(-13.4±2.7)vs.(-11.7±3.4),t=0.35,P=0.615].FIFS-19[(-5.2±4.6)vs.(-10.5±6.4),t=4.128,P=0.254].Conclusions Compared with laparoscopi
作者
杨晓飞
李永柏
张东兴
张忠民
王润华
Yang Xiaofei;Li Yongbai;Zhang Dongxing;Zhang Zhongmin;Wang Runhua(Department of Gastrointestinal Surgery,Guizhou Provincial People's Hospital,Guiyang 550000,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2023年第9期678-684,共7页
Chinese Journal of General Surgery
关键词
直肠肿瘤
排便
机器人
腹腔镜
泌尿生殖功能
Rectal neoplasms
Defection
Robotic
Laparoscopes
Urogenital function
