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中华结直肠疾病电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 516 -525. doi: 10.3877/cma.j.issn.2095-3224.2025.06.005

论著

国产手术机器人与腹腔镜在直肠癌患者术后短期疗效对比分析
唐鑫, 管子龙, 朱爽, 刘方舟, 孙国栋, 王天阳, 石云浩, 齐浩楠, 刘云霄, 王佳琦, 袁子茗, 张巍远, 黄睿()   
  1. 150081 哈尔滨医科大学附属第二医院肿瘤中心/结直肠肿瘤外科
  • 收稿日期:2025-08-30 出版日期:2025-12-25
  • 通信作者: 黄睿
  • 基金资助:
    黑龙江省自然科学基金联合引导项目(No.PL2024H118)

Comparative analysis of short-term efficacy between domestic surgical robots and laparoscopy in postoperative rectal cancer patients

Xin Tang, Zilong Guan, Shuang Zhu, Fangzhou Liu, Guodong Sun, Tianyang Wang, Yunhao Shi, Haonan Qi, Yunxiao Liu, Jiaqi Wang, Ziming Yuan, Weiyuan Zhang, Rui Huang()   

  1. Department of Center of Cancer, Colorectal Oncological Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
  • Received:2025-08-30 Published:2025-12-25
  • Corresponding author: Rui Huang
引用本文:

唐鑫, 管子龙, 朱爽, 刘方舟, 孙国栋, 王天阳, 石云浩, 齐浩楠, 刘云霄, 王佳琦, 袁子茗, 张巍远, 黄睿. 国产手术机器人与腹腔镜在直肠癌患者术后短期疗效对比分析[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 516-525.

Xin Tang, Zilong Guan, Shuang Zhu, Fangzhou Liu, Guodong Sun, Tianyang Wang, Yunhao Shi, Haonan Qi, Yunxiao Liu, Jiaqi Wang, Ziming Yuan, Weiyuan Zhang, Rui Huang. Comparative analysis of short-term efficacy between domestic surgical robots and laparoscopy in postoperative rectal cancer patients[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(06): 516-525.

目的

对比国产机器人与腹腔镜用于直肠癌患者根治术后的短期疗效。

方法

回顾性分析哈尔滨医科大学附属第二医院结直肠肿瘤外科接受直肠癌根治术治疗的直肠癌患者的临床资料,共476例患者纳入研究,其中国产机器人组(K组)50例,腹腔镜组(L组)426例,PSM后国产机器人组(K组)39例,腹腔镜组(L组)114例。K组应用KD-SR-01系统手术机器人,L组应用传统腹腔镜系统。比较两组术后并发症及术后相关结果。

结果

所有患者均手术成功,无中转开腹及姑息手术情况,手术成功率为100%。与L组比较,K组术后并发症发生率更低(χ2=3.959,P=0.047)、术中出血量更少(Z=−5.155,P<0.001)及术后首次排气时间更短(Z=−5.692,P<0.001)。NASA-TLX评分提示在术者主观体力需求方面,K组明显优于L组(Z=−3.25,P=0.001)。术后第一天,K组中性粒细胞计数显著低于L组(t=−2.07,P=0.04);术后第五天,K组白细胞计数及中性粒细胞计数显著低于L组(t=−4.57,P<0.001;t=−5.32,P<0.001)。同时在肥胖/超重患者中,K组较L组术后并发症发生率更低、术中出血更少及术后首次排气时间更短;在术后病理方面除K组中(χ2=6.12,P=0.013)淋巴管侵犯更多外,其余指标两组差异无统计学意义。

结论

对比腹腔镜,国产机器人应用在直肠癌患者根治术后短期疗效中,并发症发生率更低、术中出血量更少、术后排气更快、术后炎症水平更低且对于术者体力消耗更少,对比超重及肥胖的直肠癌患者具有更加低的术后并发症发生率、更少的出血量及更快的排气时间。

Objective

Comparison of short-term efficacy between domestic robot and laparoscope in patients undergoing radical resection for rectal cancer.

Methods

A retrospective analysis was conducted on the clinical data of rectal cancer patients who underwent radical resection of rectal cancer in the Department of Colorectal Oncology, the Second Affiliated Hospital of Harbin Medical University. A total of 476 patients were enrolled in the study, including 50 cases in the domestic robot group (Group K) and 426 cases in the laparoscopic group (Group L). After propensity score matching (PSM), there were 39 cases in Group K and 114 cases in Group L. Group K used the KD-SR-01 surgical robot system, while Group L used the traditional laparoscopic system. The postoperative complications and other postoperative - related outcomes were compared between the two groups.

Results

All patients underwent successful surgery, with no conversion to open surgery or palliative surgery, resulting in a 100% surgical success rate. Compared with Group L, Group K showed a lower incidence of postoperative complications (χ2=3.959, P=0.047), less intraoperative blood loss (Z=−5.155, P<0.001), and a shorter time to first postoperative flatus (Z=−5.692, P<0.001). The NASA-TLX score indicated that Group K was significantly superior to Group L in terms of the surgeon’s subjective physical demand (Z=−3.25, P=0.001). On the first postoperative day, the neutrophil count in Group K was significantly lower than that in Group L (t=−2.07, P=0.04). On the fifth postoperative day, both the white blood cell count and neutrophil count in Group K were significantly lower than those in Group L (white blood cell count: t=−4.57, P<0.001; neutrophil count: t=−5.32, P<0.001). Meanwhile, among obese/overweight patients, Group K had a lower incidence of postoperative complications, less intraoperative blood loss, and a shorter time to first postoperative flatus compared with Group L. In terms of postoperative pathology, the two groups showed similar results in all indicators except that Group K had more lymphovascular invasion (χ2=6.12, P=0.013).

Conclusion

Compared with laparoscopy, the application of domestic surgical robot in the short-term efficacy after radical resection for rectal cancer patients shows lower incidence of complications, less intraoperative blood loss, faster postoperative flatus, lower postoperative inflammatory levels, and less physical consumption for surgeons. For overweight and obese rectal cancer patients, the domestic surgical robot also provides lower incidence of postoperative complications, less blood loss, and faster time to first flatus

图1 KD-SR-01产品示意图。1A:手术控制台,1B:患者手术平台,1C:影像台车
图2 纳入实验患者流程图
图3 康多机器人直肠癌手术戳卡布局
表1 两组术前临床特征比较[±s,例(%)]
指标 PSM前 PSM后
K组(n=50) L组(n=426) 检验值 P K组(n=39) L组(n=114) 检验值 P
性别     χ2=5.628 0.018     χ2=0.259 0.611
男性 25(50) 285(66.9)     21(53.8) 56(49.1)    
女性 25(50) 141(33.1)     18(46.2) 58(50.9)    
年龄(岁) 65.75±9.52 62.37±9.97 t=1.619 0.11 61.49±10.86 61.53±10.67 t=−0.02 0.984
BMI(kg/m2 24.08±3.43 23.24±3.22 t=1.248 0.21 24.24±3.46 23.93±3.06 t=0.543 0.588
ASA分级     χ2=1.693 0.193     1
0 14(3.3)     0 0    
50 412(96.7)     39(100) 114(100)    
基础疾病                
糖尿病 14(28) 75(17.6) χ2=3.18 0.075 10(25.6) 23(20.2) χ2=0.513 0.474
高血压 13(22) 121(28.4) χ2=0.128 0.721 11(28.2) 32(28.1) χ2=0.00 0.987
冠心病 4(8) 43(10.1) χ2=0.220 0.639 2(5.3) 6(5.3) χ2=0.01 0.974
脑血管病 6(12) 4(0.9) χ2=16.62 <0.001 0(0) 0(0) 1
手术史 16(32) 149(35) χ2=0.175 0.676 11(28.2) 32(28.1) χ2=0.00 0.987
肿瘤位置     χ2=11.93 0.003     χ2=2.231 0.328
高位 8(16) 74(17.6)     6(15.4) 24(21.1)    
中位 40(80) 248(58.2)     31(79.5) 77(52.6)    
低位 2(4) 104(24.4)     2(5.1) 13(26.3)    
T分期     χ2=26.64 <0.001     χ2=3.777 0.287
T1 0(0) 10(2.3)     0(0) 3(2.6)    
T2 18(36) 47(11)     16(41) 30(26.3)    
T3 20(40) 209(49.1)     15(38.5) 51(44.7)    
T4a 12(24) 160(37.6)     8(20.5) 30(26.3)    
N分期     χ2=4.611 0.097     χ2=0.707 0.702
N0 26(52) 270(63.3)     25(64.1) 74(64.6)    
N1 16(32) 81(19)     10(25.6) 25(22.1)    
N2 8(16) 75(17.6)     4(10.3) 15(13.3)    
表2 PSM后两组术后病理特征比较[例(%)]
表3 两组术后疗效比较[±s,例(%)]
表4 两组术后并发症发生率比较[例(%)]
表5 两组NASA-TLX评分比较[Median(Q1,Q3)]
图4 术后患者血液检查结果折线图。4A:为白细胞计数(WBC)折线图,4B:为中性粒细胞计数(Neu)折线图,4C:为血红蛋白(Hb)折线图
表6 两组术后白细胞计数检查结果(±s
表7 两组术后中性粒细胞计数检查结果(±s
表8 两组术后血红蛋白检查结果(±s
表9 正常亚组与超重及肥胖亚组术后疗效比较[±s,例(%)]
[1]
Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(3): 233-254.
[2]
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[3]
Jiang WZ, Xu JM, Xing JD, et al. Short-term outcomes of laparoscopy-assisted vs. open surgery for patients with low rectal cancer: the LASRE randomized clinical trial[J]. JAMA Oncol, 2022, 8(11): 1607-1615.
[4]
Harsløf S, Stouge A, Thomassen N, et al. Outcome one year after robot-assisted rectal cancer surgery: a consecutive cohort study[J]. Int J Colorectal Dis, 2017, 32(12): 1749-1758.
[5]
Park JS, Lee SM, Choi GS, et al. Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial[J]. Ann Surg, 2023, 278(1): 31-38.
[6]
Feng Q, Yuan W, Li T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(11): 991-1004.
[7]
Reyes DA, Tang B, Cuschieri A. Minimal access surgery (MAS)-related surgeon morbidity syndromes[J]. Surg Endosc, 2006, 20(1): 1-13.
[8]
Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer[J]. Gut, 2013, 62(6): 933-947.
[9]
Albayati S, Hitos K, Berney CR, et al. Robotic-assisted versus laparoscopic rectal surgery in obese and morbidly obese patients: ACS-NSQIP analysis[J]. J Robot Surg, 2022, 17(2): 637-643.
[10]
Park EJ, Baik SH. Robotic surgery for colon and rectal cancer[J]. Curr Oncol Rep, 2016, 18(1): 5.
[11]
Fan S, Zhang Z, Wang J, et al. Robot-assisted radical prostatectomy using the KangDuo Surgical Robot-01 system: a prospective, single-center, single-arm clinical study[J]. J Urol, 2022, 208(1): 119-127.
[12]
Xiong S, Fan S, Chen S, et al. Robotic urologic surgery using the KangDuo-Surgical Robot-01 system: a single-center prospective analysis[J]. Chin Med J (Engl), 2023, 136(24): 2960-2966.
[13]
Wang J, Fan S, Shen C, et al. Partial nephrectomy through retroperitoneal approach with a new surgical robot system, KD‐SR‐01[J]. Int J Med Robot, 2022, 18(2): e2352.
[14]
Shen C, Yan W, Chen S, et al. Robot-assisted radical prostatectomy with the KangDuo Surgical System versus the da Vinci Si System: a prospective, double-center, randomized controlled trial[J]. Eur Urol Focus, 2024, 10(6): 1019-1026.
[15]
Dai X, Fan S, Hao H, et al. Comparison of KD‐SR‐01 robotic partial nephrectomy and 3D‐laparoscopic partial nephrectomy from an operative and ergonomic perspective: a prospective randomized controlled study in porcine models[J]. Int J Med Robot, 2021, 17(2): e2187.
[16]
Liu Y, Wang Y, Wang C, et al. Comparison of short-term outcomes of robotic-assisted radical colon cancer surgery using the Kangduo Surgical Robotic System and the Da Vinci Si Robotic System: a prospective cohort study[J]. Int J Surg, 2024, 110(3): 1511-1518.
[17]
Cao A, Chintamani KK, Pandya AK, et al. NASA TLX: software for assessing subjective mental workload[J]. Behav Res Methods, 2009, 41(1): 113-117.
[18]
Zhang Z, Li Z, Xu W, et al. Robot-assisted radical nephroureterectomy using the KangDuo Surgical Robot-01 System versus the da Vinci System: a multicenter prospective randomized controlled trial[J]. Int Braz J Urol, 2024, 50(6): 727-736.
[19]
Bardou M, Rouland A, Martel M, et al. Review article: obesity and colorectal cancer[J]. Aliment Pharmacol Ther, 2022, 56(3): 407-418.
[20]
Baastrup NN, Christensen JK, Jensen KK, et al. Visceral obesity and short-term outcomes after laparoscopic rectal cancer resection[J]. Surg Endosc, 2020, 34(1): 177-185.
[21]
Quezada-Diaz FF, Smith JJ. Options for low rectal cancer: robotic total mesorectal excision[J]. Clin Colon Rectal Surg, 2021, 34(5): 311-316.
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