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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (05) : 381 -387. doi: 10.3877/cma.j.issn.2095-3224.2023.05.004

论著

达芬奇机器人对比腹腔镜在低位直肠癌APR手术中盆底腹膜关闭联合腹膜外造口的应用研究
嵇晋, 管锦坤, 汪刘华, 王伟, 任俊, 张琪, 王道荣, 马从超()   
  1. 224700 建湖县人民医院胃肠外科;225001 扬州大学临床医学院;225001 扬州,江苏省苏北人民医院胃肠外科
    224700 建湖县人民医院胃肠外科
    225001 扬州,江苏省苏北人民医院胃肠外科
    225001 扬州大学临床医学院;225001 扬州,江苏省苏北人民医院胃肠外科
  • 收稿日期:2023-01-29 出版日期:2023-10-25
  • 通信作者: 马从超
  • 基金资助:
    江苏省扬州市科技计划项目(YZ2020159)

A study of the Da Vinci robot contrast laparoscopy in APR surgery for low rectal cancer with pelvic floor peritoneal closure combined with extraperitoneal stoma

Jin Ji, Jinkun Guan, Liuhua Wang, Wei Wang, Jun Ren, Qi Zhang, Daorong Wang, Congchao Ma()   

  1. Department of Gastrointestinal Surgery, Jianhu County People's Hospital, Jianhu 224700, China; School of Clinical Medicine, Yangzhou University,Yangzhou 225001, China; Department of Gastrointestinal Surgery,Northern Jiangsu People's Hospital,Yangzhou 225001, China
    Department of Gastrointestinal Surgery, Jianhu County People's Hospital, Jianhu 224700, China
    Department of Gastrointestinal Surgery,Northern Jiangsu People's Hospital,Yangzhou 225001, China
    School of Clinical Medicine, Yangzhou University,Yangzhou 225001, China; Department of Gastrointestinal Surgery,Northern Jiangsu People's Hospital,Yangzhou 225001, China
  • Received:2023-01-29 Published:2023-10-25
  • Corresponding author: Congchao Ma
引用本文:

嵇晋, 管锦坤, 汪刘华, 王伟, 任俊, 张琪, 王道荣, 马从超. 达芬奇机器人对比腹腔镜在低位直肠癌APR手术中盆底腹膜关闭联合腹膜外造口的应用研究[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(05): 381-387.

Jin Ji, Jinkun Guan, Liuhua Wang, Wei Wang, Jun Ren, Qi Zhang, Daorong Wang, Congchao Ma. A study of the Da Vinci robot contrast laparoscopy in APR surgery for low rectal cancer with pelvic floor peritoneal closure combined with extraperitoneal stoma[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(05): 381-387.

目的

探讨达芬奇机器人对比腹腔镜关闭盆底腹膜联合腹膜外造口在低位直肠癌腹会阴联合切除术(APR)中的应用效果。

方法

回顾性分析2019年5月~2022年5月在江苏省苏北人民医院胃肠中心实施APR手术的低位直肠癌患者临床资料,按手术方式分为RAPR组(达芬奇机器人手术28例)和LAPR组(腹腔镜手术31例)。

结果

两组术中出血量、首次排气排便时间、引流管拔出时间、尿管拔出时间、住院时间、肿瘤直径、肿瘤分化程度、TNM分期、术后造口并发症、术后部分会阴部并发症及男性性功能方面比较,差异无统计学意义(P>0.05),RAPR组相比于LAPR组,手术时间长(185.2±36.1 min vs. 153.5±34.2 min,t=3.467,P=0.001),淋巴结清扫数目多(16.5±3.8枚vs. 14.3±3.5枚,t=2.322,P=0.024)、会阴切口感染率低(7.1% vs. 29.0%,χ2=4.647,P=0.045)、会阴切口裂开率低(3.6% vs. 25.8%,P=0.027),患者术后夜尿次数少(1.00±0.82次vs. 1.48±0.89次,t=-2.169,P=0.034)、排尿功能好(P=0.026)。

结论

运用达芬奇机器人进行盆底腹膜关闭联合腹膜外造口是安全可行的,可提高淋巴结清扫数目,降低部分会阴部并发症发生率,患者术后夜尿次数少,排尿功能好,在临床中具有一定的实用价值。

Objective

Exploring the effect of Da Vinci robot contrast laparoscopy to close the pelvic floor peritoneum combined with extraperitoneal stoma in abdominoperineal resection(APR) for low rectal cancer.

Methods

The clinical data of patients with low rectal cancer who underwent APR surgery at Gastrointestinal Center of Northern Jiangsu People's Hospital from May 2019 to May 2022 were retrospectively analyzed and divided into RAPR group (28 cases of Da Vinci robot surgery) and LAPR group (31 cases of laparoscopic surgery) according to the surgical method.

Results

There were no statistically significant differences in intraoperative bleeding, time to first defecation, time to drainage tube removal, time to urinary catheter removal, hospital stay, tumor diameter, tumor differentiation degree, TNM stage, postoperative stoma complications, some postoperative perineal complications and male sexuality between the two groups (P>0.05), and the RAPR group had a longer operative time compared to the LAPR group (185.2±36.1 min vs. 153.5±34.2 min, t=3.467, P=0.001), and also improved the number of lymph node dissection (16.5±3.8 vs. 14.3±3.5, t=2.322, P=0.024), and have a low rate of perineal incision infection (7.1% vs. 29.0%, χ2=4.647, P=0.045), low rate of perineal incision dehiscence (3.6% vs. 25.8%, P=0.027), and patients had less postoperative nocturnal urination (1.00±0.82 vs. 1.48±0.89, t=-2.169, P=0.034) and better voiding function (P=0.026).

Conclusion

The use of the Da Vinci robot for pelvic floor peritoneal closure combined with an extraperitoneal stoma is safe and feasible, and can improve the number of lymph nodes cleared and reduce the incidence of some complications, and provide patients with fewer postoperative nocturnal urinations and better voiding function, which has some practical value in clinical practice.

表1 两组患者临床资料比较
图1 RAPR组手术方法。1A:在骶骨岬处用3-0可吸收线缝合两侧腹膜1针;1B:倒刺线关闭盆底腹膜;1C:缝合完毕后末端用Hemo-lock夹闭;1D:机器人电剪刀游离乙状结肠根部外侧腹膜,向左侧腹预造口方向分离隧道;1E:用卵圆钳向左后侧腹壁方向钝性分离隧道与腹腔相通;1F:使用Hemo-lock夹闭侧腹膜间隙;1G:行乙状结肠单腔造口
表2 两组患者围手术期资料比较(
x¯
±s
表3 两组患者术后病理结果比较[
x¯
±s,例(%)]
表4 两组患者术后造口并发症比较[例(%)]
表5 两组患者术后会阴部并发症比较[例(%)]
表6 两组患者术后植物神经功能比较(
x¯
±s
[1]
Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5): 584-590.
[2]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[3]
Battersby NJ, Moran B, Yu S , et al. MR imaging for rectal cancer: the role in staging the primary and response to neoadjuvant therapy[J]. Expert Rev Gastroenterol Hepatol, 2014, 8(6): 703-719.
[4]
Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3): 145-164.
[5]
吴春晓, 顾凯, 龚杨明, 等. 2015年中国结直肠癌发病和死亡情况分析[J]. 中国癌症杂志, 2020, 30(4): 241-245.
[6]
吴胜文, 乔婷婷, 马从超. 腹腔镜低位直肠癌根治术中应用盆腔腹膜关闭技术的疗效研究[J].中国现代普通外科进展, 2021, 24(2): 112-115.
[7]
Wang S, Meng Q, Gao J, et al. The application of extraperitoneal ostomy combined with pelvic peritoneal reconstruction in laparoscopic abdominoperineal resection for rectal cancer[J]. Gastroenterol Res Pract, 2019, 2019: 3015958.
[8]
Buunen M, Bonjer HJ, Hop W, et al. COLOR II-A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer[J]. Dan Med Bull, 2009, 56(2): 89-91.
[9]
Hgm VDPM, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial[J]. Lancet Oncol, 2013, 14(3): 210-218.
[10]
Liang X, Hou S, Liu H, et al. Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(5): 381-385.
[11]
王举, 王永强, 姜洪伟, 等. 腹腔镜下腹膜外造口联合盆底腹膜重建的应用[J]. 中华腔镜外科杂志(电子版), 2015, 8(1): 43-48.
[12]
Yasser D, Ashraf Z, Ahmed F, et al. Robotic-assisted versus conventional laparoscopic approach for rectal cancer surgery, first egyptian academic center experience, RCT[J]. Minim Invasive Surg, 2018, 2018: 5836562.
[13]
中国医师协会结直肠肿瘤专业委员会机器人手术专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人结直肠癌手术中国专家共识(2020版)[J]. 中华消化外科杂志, 2021, 20(1): 16-28.
[14]
刘学. 系统性排尿训练对直肠癌根治术后病人排尿功能的影响分析[J]. 影像研究与医学应用, 2018, 2(8): 24-26.
[15]
Wang G, Wang Z, Jiang Z, et al. Male urinary and sexual function after robotic pelvic autonomic nerve‐preserving surgery for rectal cancer[J]. Int J Med Robot, 2017, 13(1).
[16]
宋学舜. 保留盆腔自主神经对低位直肠癌根治术男性患者排尿及性功能的影响[J]. 中国实用神经疾病杂志, 2014, 17(17): 83-84.
[17]
杜晓辉. 机器人与腹腔镜直肠癌前切除术近期疗效对比研究[J]. 中国实用外科杂志, 2016, 36(11): 1180-1182.
[18]
Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review[J]. Journal of Gastrointestinal Surgery, 2014, 18(4): 816-830.
[19]
徐舟舟, 朱晒红, 易波, 等. 达芬奇机器人手术系统与腹腔镜全直肠系膜切除术治疗低位直肠癌的疗效分析[J]. 中华消化外科杂志, 2020, 19(5): 537-543.
[20]
谭可, 胡康, 田跃, 等. 机器人与腹腔镜直肠癌根治术疗效对比分析: 一项倾向性评分匹配队列研究[J]. 中国实用外科杂志, 2022, 42(8): 906-912+919.
[21]
卓凡, 李太原, 孙焕奎, 等. 倾向性评分匹配达芬奇机器人与腹腔镜直肠癌低位前切除术的近期疗效比较[J]. 实用医学杂志, 2019, 35(9): 1468-1472.
[22]
雷伟琦, 张东, 刘莱蓬, 等. 机器人与腹腔镜直肠癌全系膜切除术近期疗效对比的Meta分析[J].实用医学杂志, 2016, 32(17): 2903-2907.
[23]
Yasukawa D, Hori T, Kadokawa Y, et al. Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer[J]. Surg Endosc, 2019, 33(2): 437-447.
[24]
钱国武, 宋展, 吕柯, 等. 倒刺缝线关闭盆底腹膜联合骶前双套管负压冲洗引流在腹腔镜直肠前切除中的应用[J]. 中华普通外科杂志, 2018, 33(12): 1034-1037.
[25]
McLean R, Kipling M, Musgrave E, et al. Short- and long-term clinical and patient-reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients[J]. Colorectal Dis, 2018, 20(5): 424-436.
[26]
Ercoli A, Cosma S, Riboni F, et al. Laparoscopic nerve-preserving sacropexy[J]. J Minim Invasive Gynecol, 2017, 24(7): 1075-1077.
[27]
梁小波, 王毅, 马国龙. "膜"引导保护盆腔植物神经技术在直肠癌手术中的应用[J]. 中华胃肠外科杂志, 2017, 20(6): 614-617.
[28]
李震, 王世豪, 李国宾, 等. 机器人和腹腔镜及开腹手术治疗重度直肠脱垂的临床效果比较[J].中华胃肠外科杂志, 2020, 23(12): 1187-1193.
[29]
Park SY, Choi GS, Park JS, et al. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison[J].World Journal of Surgery, 2014, 38(7): 1834-1842.
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