Shevchenko Yu L, Karpov O E, Vetshev P S, Maksimenkov A V, Stepanyuk I V, Stoyko Yu M, Levchuk A L, Nazarov V A, Kolozyan D A
Pirogov National Medical and Surgical Center of Healthcare Ministry of the Russian Federation, Moscow, Russia.
Khirurgiia (Mosk). 2018(2):66-73. doi: 10.17116/hirurgia2018266-73.
To analyze immediate outcomes of 286 laparoscopic and robot-assisted interventions on the colon and rectum.
There were 256 (89.51%) laparoscopic and 30 (10.49%) robot-assisted procedures. 233 (81.46%) operations were performed for rectum and colon cancer. Postoperative complications after colon cancer surgery were revealed in 11.11%, including anastomosis failure in 2.08% of cases. Postoperative complications after rectal cancer surgery occurred in 32.58% of cases including anastomosis failure after anterior rectectomy in 11.67%.
Robot-assisted surgery is not advisable for colon diseases according to price-effectiveness ratio due to available laparoscopic approach. Preventive intestinal stoma in endoscopic low and ultra-low anterior rectal resection allows you to avoid clinically significant inconsistency of colorectal anastomosis. Laparoscopic procedure should be performed with Contour stitching-cutting device in low and ultra-low anterior rectal resection if there is technical complexity of one-stage rectum intersection below the tumor. Robot-assisted operations for rectal cancer have advantages due to three-dimensional imaging and better orientation, greater freedom of manipulation in confined spaces, and simplicity of lymphadenectomy.
分析286例腹腔镜及机器人辅助结肠和直肠手术的近期疗效。
其中256例（89.51%）为腹腔镜手术，30例（10.49%）为机器人辅助手术。233例（81.46%）手术针对直肠癌和结肠癌。结肠癌手术后的术后并发症发生率为11.11%，其中吻合口漏发生率为2.08%。直肠癌手术后的术后并发症发生率为32.58%，其中直肠前切除术后吻合口漏发生率为11.67%。
鉴于现有的腹腔镜手术方法，从性价比来看，机器人辅助手术不适用于结肠疾病。内镜下低位及超低位直肠前切除术中预防性肠造口可避免结直肠吻合口出现具有临床意义的不愈合情况。如果在肿瘤下方进行一期直肠吻合存在技术复杂性，在低位及超低位直肠前切除术中应使用轮廓缝合切割装置进行腹腔镜手术。机器人辅助直肠癌手术具有优势，因其具备三维成像和更好的定位、在有限空间内更大的操作自由度以及淋巴结清扫的简便性。
