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直肠癌的经肛门全直肠系膜切除术:在单中心应用腹腔镜和机器人技术治疗的连续 70 例患者——累积经验。

TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique-cumulative experience in a single centre.

机构信息

Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, IT, Italy.

Vita-Salute San Raffaele University, 20132, Milan, Italy.

出版信息

Updates Surg. 2019 Jun;71(2):331-338. doi: 10.1007/s13304-019-00655-y. Epub 2019 Apr 26.

Abstract

From January 2011 to December 2015, 70 consecutive patients underwent either laparoscopic surgery (LS) or robotic surgery (RS) total mesorectal excision (TME) for malignancy. Data were prospectically recorded in a dedicated local database including ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results. We enrolled 70 consecutive patients, 35 treated with LS (18 M, 17 F), 35 treated with RS (23 M, 12 F). Median total operative time was 225 min in LS group (IQR 194-255) and 252.5 min for RS group (IQR 214-300). Median first flatus time was 2 days for LS group (IQR 1-3) and 1 day for RS group (IQR 1-2). Stool discharge time (median) was 4 days for LS group (IQR 2-5) and 2 days for RS group (IQR 1-3). Length of stay (median) was 8 days in LS group (IQR 7-10) and 7 days in RS group (IQR 5-8). It was not found any statistically significant difference between the two groups when we analyzed the number nodes harvested the postoperative complications. The 30 day mortality was 0% in both two groups. The conversion rate for LS group was 23% (8/35 pts) and that for RS group was 0% (0/35). The RS may overcome technical limitations of LS. In our experience, it is a feasible and safe technique, it achieves better clinical outcomes due to the lower conversion rate compared to LS, although with higher costs.

摘要

从 2011 年 1 月到 2015 年 12 月,70 例连续患者接受了腹腔镜手术(LS)或机器人手术(RS)全直肠系膜切除术(TME)治疗恶性肿瘤。数据前瞻性地记录在一个专门的本地数据库中,包括 ASA 评分、年龄、手术时间、转化率、再手术率、早期并发症、住院时间和病理结果。我们纳入了 70 例连续患者,其中 35 例接受 LS(18 例男性,17 例女性),35 例接受 RS(23 例男性,12 例女性)。LS 组的总手术时间中位数为 225 分钟(IQR 194-255),RS 组为 252.5 分钟(IQR 214-300)。LS 组的首次放屁时间中位数为 2 天(IQR 1-3),RS 组为 1 天(IQR 1-2)。LS 组的粪便排出时间(中位数)为 4 天(IQR 2-5),RS 组为 2 天(IQR 1-3)。LS 组的住院时间(中位数)为 8 天(IQR 7-10),RS 组为 7 天(IQR 5-8)。当我们分析术后并发症时,两组之间的淋巴结采集数量没有统计学上的显著差异。两组的 30 天死亡率均为 0%。LS 组的转化率为 23%(8/35 例),RS 组为 0%(0/35 例)。RS 可能克服 LS 的技术限制。根据我们的经验,与 LS 相比,RS 具有更低的转化率,因此能取得更好的临床效果,尽管成本更高,但它是一种可行且安全的技术。

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