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机器人辅助与腹腔镜半肝切除术:来自单一中心的比较研究

Robotic vs laparoscopic hemihepatectomy: A comparative study from a single center.

作者信息

Wang Zi-Zheng, Tang Wen-Bo, Hu Ming-Gen, Zhao Zhi-Ming, Zhao Guo-Dong, Li Cheng-Gang, Tan Xiang-Long, Zhang Xuan, Lau Wan Yee, Liu Rong

机构信息

Department of Hepatopancreatobiliary Surgical Oncology, Military Institution of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.

Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.

出版信息

J Surg Oncol. 2019 Sep;120(4):646-653. doi: 10.1002/jso.25640. Epub 2019 Jul 16.

Abstract

BACKGROUND

Robotic surgery is increasingly being used in hepatectomy. Previous studies comparing the robotic and laparoscopic minor hepatectomy have been documented, but comparative studies on robotic and laparoscopic hemihepatectomy (LH) involving a large patient cohort are rare. The objective of this study was to compare perioperative outcomes between robotic and LH.

METHODS

Data on the demographics, clinicopathologic characteristics, and perioperative outcomes of consecutive patients who underwent robotic or LH in a single center between November 2011 and July 2017 were analyzed.

RESULTS

A total of 92 patients underwent robotic and 48 LH. Multiple linear regression analysis showed no significant difference in perioperative outcomes including operative time, postoperative hospital stay, postoperative complications, and mortality between the groups. Compared to the laparoscopic cohort, the robotic cohort had a significantly less estimated blood loss (120.24 mL; 95% confidence interval, 53.72-186.76) and a significantly lower conversation rate (1.09% vs 10.42%; P = .034). Stratified and interaction analyses demonstrated that disease type had an interaction effect on the association between the operative approach and the estimated blood loss.

CONCLUSIONS

Robotic hemihepatectomy was safe and feasible in selected patients. It had similar perioperative outcomes as LH and was better than LH regarding estimated blood loss and open conversion.

摘要

背景

机器人手术在肝切除术中的应用日益广泛。此前已有比较机器人辅助与腹腔镜下小范围肝切除术的研究报道,但涉及大量患者队列的机器人辅助与腹腔镜半肝切除术(LH)的比较研究较少。本研究的目的是比较机器人辅助半肝切除术与腹腔镜半肝切除术的围手术期结局。

方法

分析了2011年11月至2017年7月在单一中心接受机器人辅助或腹腔镜半肝切除术的连续患者的人口统计学、临床病理特征及围手术期结局数据。

结果

共有92例患者接受了机器人辅助半肝切除术,48例接受了腹腔镜半肝切除术。多元线性回归分析显示,两组在包括手术时间、术后住院时间、术后并发症及死亡率等围手术期结局方面无显著差异。与腹腔镜组相比,机器人辅助组的估计失血量显著更少(120.24 mL;95%置信区间,53.72 - 186.76),中转开腹率显著更低(1.09%对10.42%;P = 0.034)。分层及交互分析表明,疾病类型对手术方式与估计失血量之间的关联存在交互作用。

结论

机器人辅助半肝切除术在选定患者中是安全可行的。其围手术期结局与腹腔镜半肝切除术相似,在估计失血量及中转开腹方面优于腹腔镜半肝切除术。

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