机器人与腹腔镜下保留神经的根治性子宫切除术治疗宫颈癌：单中心经验初步比较术中及围手术期结果。
Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience.
机构信息
Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
出版信息
Int J Gynecol Cancer. 2013 Jul;23(6):1145-9. doi: 10.1097/IGC.0b013e31829a5db0.
OBJECTIVE
The aim of the study was to compare the initial surgical outcomes and learning curve of nerve-sparing robotic radical hysterectomy (RRH) with nerve-sparing total laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in the first 50 cases.
METHODS
Between January 2008 and March 2012, 50 consecutive patients underwent nerve-sparing RRH. These patients were compared with a historic cohort of the first 50 consecutive patients who underwent nerve-sparing TLRH.
RESULTS
Both groups were similar with respect to patients and tumor characteristics. The mean operating time in the RRH group was significantly longer than that in the TLRH group (230.1 ± 35.8 vs 211.2 ± 46.7 minutes; P = 0.025). The mean blood loss for the robotic group was significantly lower compared with the laparoscopic group (54.9 ± 31.5 vs 201.9 ± 148.4 mL; P < 0.001). There was no significant difference in the mean pelvic lymph nodes between the 2 groups (25.0 ± 9.9 vs 23.1 ± 10.4; P = 0.361). The mean days to normal residual urine were 9.6 ± 6.4 in RRH and 11.0 ± 6.2 in TLRH (P = 0.291). The incidence of intraoperative complication was profoundly lower in RRH compared with that of TLRH (0% vs 8%; P = 0.041). Moreover, no intraoperative transfusion was required in RRH, whereas 4 (8%) were required in TLRH (P = 0.041). In both groups, we found no evidence of a learning effect during the first 50 cases.
CONCLUSIONS
During the first 50 cases, surgical outcomes and complication rates of nerve-sparing RRH were found to be comparable to those of nerve-sparing TLRH. Moreover, the mean blood loss and intraoperative complication rate in the robotic group were significantly lower than those in the laparoscopic group. Surgical skills for nerve-sparing TLRH easily and safely translated to nerve-sparing RRH in case of experienced laparoscopic surgeon.
目的
本研究旨在比较前 50 例接受保留神经的机器人根治性子宫切除术（RRH）与前 50 例接受保留神经的全腹腔镜根治性子宫切除术（TLRH）治疗早期宫颈癌的初始手术结果和学习曲线。
方法
2008 年 1 月至 2012 年 3 月，50 例连续患者接受了保留神经的 RRH。这些患者与前 50 例连续接受保留神经的 TLRH 的患者进行了比较。
结果
两组患者和肿瘤特征相似。RRH 组的平均手术时间明显长于 TLRH 组（230.1±35.8 分钟 vs 211.2±46.7 分钟；P=0.025）。机器人组的平均出血量明显低于腹腔镜组（54.9±31.5 毫升 vs 201.9±148.4 毫升；P<0.001）。两组间平均盆腔淋巴结无显著差异（25.0±9.9 个 vs 23.1±10.4 个；P=0.361）。RRH 组术后正常残余尿天数为 9.6±6.4 天，TLRH 组为 11.0±6.2 天（P=0.291）。RRH 组术中并发症发生率明显低于 TLRH 组（0% vs 8%；P=0.041）。此外，RRH 组无需术中输血，而 TLRH 组有 4 例（8%）需要输血（P=0.041）。在两组中，我们在最初的 50 例中均未发现学习效应的证据。
结论
在前 50 例中，保留神经的 RRH 的手术结果和并发症发生率与保留神经的 TLRH 相当。此外，机器人组的平均出血量和术中并发症发生率明显低于腹腔镜组。有经验的腹腔镜外科医生可以轻松、安全地将保留神经的 TLRH 手术技能转化为保留神经的 RRH。
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