基于并发症发生率的比较：开放性、腹腔镜和机器人辅助根治性前列腺切除术的效果比较：来自瑞士行政数据的回顾性观察研究。
Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland.
机构信息
Technische Universität Berlin (WHO Collaborating Centre for Health Systems Research and Management), Berlin, Germany.
Spital Männedorf AG/Zürich, Männedorf, Switzerland.
出版信息
BMC Urol. 2024 Oct 7;24(1):215. doi: 10.1186/s12894-024-01597-3.
BACKGROUND
Radical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.
METHODS
The data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.
RESULTS
A procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.
DISCUSSION
The use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.
背景
根治性前列腺切除术可通过开放式经耻骨后、腹腔镜或机器人辅助腹腔镜手术进行。文献表明，短期结果（特别是住院并发症）因手术类型而异。迄今为止，这些差异仅根据国家常规数据在孤立病例中进行了检查和确认。
方法
该数据基于瑞士 2016 年至 2018 年的医疗统计数据，来自瑞士所有医院行政数据的全国调查。病例包括编码主要疾病前列腺肿瘤（ICD C61）和主要治疗方法腹腔镜（CHOP 60.5X.20）或经耻骨后（CHOP 60.5X.30）根治性前列腺切除术，总样本量为 8593 例。
结果
998 例（11.6%）发生与手术相关的并发症。按手术方式，机器人辅助腹腔镜根治性前列腺切除术的并发症发生率为 10.1%，传统腹腔镜根治性前列腺切除术为 9.0%，开放式经耻骨后根治性前列腺切除术为 17.1%（p<0.001）。传统和机器人辅助腹腔镜根治性前列腺切除术的并发症风险明显低于经耻骨后手术。此外，经耻骨后手术的病例发生与手术相关的并发症的风险几乎高出两倍；然而，传统腹腔镜和机器人辅助腹腔镜病例之间没有发现显著差异。
讨论
在住院期间，使用手术机器人在根治性前列腺切除术方面没有显示出与手术相关的优势。然而，传统和机器人辅助腹腔镜根治性前列腺切除术的结果均优于开放式经耻骨后手术。需要基于索赔数据对患者的长期病程进行进一步研究，以确认手术机器人的固有优势，同时也要确认其在医院中越来越多地应用。
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