發(fā)布時(shí)間：2018-06-01 03:19

  本文選題：直腸癌 + 機(jī)器人　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的比較機(jī)器人與腹腔鏡下直腸癌根治術(shù)安全性及近期療效。方法按先后順序連續(xù)選取2014年10月-2016年9月于鄭州大學(xué)第一附屬醫(yī)院肛腸外科行直腸癌根治手術(shù)的患者。其中,達(dá)芬奇機(jī)器人完成手術(shù)69例,腹腔鏡完成手術(shù)61例。兩組患者的性別、年齡、直腸癌的位置、腫瘤直徑、病程分期等無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)且具有可比性。比較兩組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后首次排氣時(shí)間、尿管拔出時(shí)間、腫瘤遠(yuǎn)切緣距離、住院天數(shù)等安全性及臨床療效指標(biāo)。結(jié)果兩組手術(shù)均順利完成,術(shù)中無(wú)中轉(zhuǎn)開(kāi)腹。機(jī)器人組和腹腔鏡組的手術(shù)時(shí)間分別是(257.49±86.25min vs 214.49±75.76min,P=0.006);機(jī)器人組按手術(shù)時(shí)間先后順序,前35例手術(shù)平均時(shí)間為(284.14±98.80)min,后34例手術(shù)平均時(shí)間為(230.05±61.17)min,且差異具有統(tǒng)計(jì)學(xué)意義(P=0.022),手術(shù)時(shí)間隨著機(jī)器人手術(shù)經(jīng)驗(yàn)積累和手術(shù)例數(shù)增多而減少;術(shù)中出血量少于腹腔鏡組(96.52±56.59ml vs 135.74±58.81 ml,P0.05);術(shù)后首次排氣時(shí)間早于腹腔鏡組(3.65±1.15 d vs 4.28±1.19 d,P0.05);尿管拔出時(shí)間早于腹腔鏡組(6.01±1.10 d vs 7.26±1.62d,P0.05);腫瘤下緣距遠(yuǎn)切緣距離大于腹腔鏡組(2.71±1.13 cm vs 2.19±1.30cm,P0.05);平均住院天數(shù)少于腹腔鏡組(13.68±1.07 d vs 14.16±1.12 d,P0.05)。術(shù)后腫瘤遠(yuǎn)端切緣組織,常規(guī)病理顯示,均未見(jiàn)癌細(xì)胞殘留。機(jī)器人組與腹腔鏡組總體并發(fā)癥發(fā)生率相似(10.14%vs 16.39%),無(wú)統(tǒng)計(jì)學(xué)差異(P=0.292)。結(jié)論機(jī)器人和腹腔鏡都可順利完成直腸癌微創(chuàng)手術(shù),機(jī)器人組手術(shù)時(shí)間略長(zhǎng)于腹腔鏡組,但機(jī)器人組在術(shù)中出血量、術(shù)后首次排氣時(shí)間、尿管拔出時(shí)間、腫瘤下緣距遠(yuǎn)切緣距離、住院天數(shù)等方面具有優(yōu)勢(shì)。
[Abstract]:Objective to compare the safety and efficacy of radical resection of rectal cancer by robotics and laparoscopy. Methods from October 2014 to September 2016, patients underwent radical rectal cancer surgery in the first affiliated Hospital of Zhengzhou University. Among them, 69 cases were performed by Leonardo da Vinci robot and 61 cases by laparoscopy. There were no significant differences in sex, age, location of rectal cancer, tumor diameter and stage of disease between the two groups (P 0.05). The safety and clinical efficacy indexes of the two groups were compared, such as operation time, intraoperative bleeding volume, first time of exhaust after operation, time of urinary catheter extraction, distance of tumor distant margin, length of stay in hospital, and so on. Results the operation was completed successfully in both groups, and there was no conversion to open operation during the operation. The operation time of robot group and laparoscopic group were 257.49 鹵86.25min vs 214.49 鹵75.76 min P0. 006 respectively. The average operation time of the first 35 cases was 284.14 鹵98.80 min, and that of the latter 34 cases was 230.05 鹵61.17 min, and the difference was statistically significant. The intraoperative bleeding was less than that in the laparoscopic group (96.52 鹵56.59ml vs 135.74 鹵58.81 ml P0.05), the time of the first postoperative venting was earlier than that of the laparoscopic group (3.65 鹵1.15 d vs 4.28 鹵1.19 d), the time of urinary catheter extraction was earlier than that of the laparoscopic group (6.01 鹵1.10 days vs 7.26 鹵1.62dP0.05), the distance from the distal margin of the tumor to the distal margin of the laparoscopic group was larger than that of the laparoscopic group (2.71 鹵1.13 cm vs 2.19 鹵1.30 cm). The average length of hospitalization was less than that of laparoscopy group (13.68 鹵1.07 days vs 14.16 鹵1.12 days, P 0.05). No residual cancer cells were found in the distal margin of the tumor after operation. The incidence of total complications in the robot group was similar to that in the laparoscopic group (10.14 vs 16.39), and there was no statistical difference between the two groups (P = 0.292). Conclusion both robot and laparoscope can successfully complete the minimally invasive surgery for rectal cancer. The operation time of robot group is a little longer than that of laparoscopy group, but the amount of blood lost during operation, the time of first exhaust after operation, the time of urinary catheter extraction in robot group are much longer than those in the control group. The distance from the lower margin to the distal margin and the length of hospitalization have advantages.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.37

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