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投稿时间：2024-10-14 网络发布日期：2025-07-21
投稿时间：2024-10-14 网络发布日期：2025-07-21
中文摘要: 目的 基于倾向性评分匹配（PSM），比较机器人与腹腔镜辅助下行结直肠癌根治术对患者围手术期各项结局指标的影响，探索机器人手术开展前、中期的最佳手术获益人群特点。方法 回顾性分析2022年1月至2023年12月重庆医科大学附属第二医院行结直肠癌根治术的患者资料，基于患者性别、年龄、身体质量指数（BMI）及手术部位进行PSM，主要结局是匹配后队列的术后短期结局（二次手术率、首次排气时间、首次进食流食时间、术后住院时间、总住院时间），次要结局是匹配后队列的术中情况（手术时间、估计失血量、术中输血率、中转开腹率、淋巴结清扫数目）和术后感染性并发症发生率。结果 本研究共纳入1031例患者资料，将机器人组（n=147）与腹腔镜组（n=884）患者进行1∶1 PSM后，共保留142对研究对象。匹配后的队列中，腹腔镜组的手术时间短于机器人组［179.48（69.88）min vs 237.98（82.27）min，U=6.849，P<0.01］，机器人组与腹腔镜组在估计失血量［50（20）mL vs 50（30）mL，U=2.746，P=0.006］、首次进食流食时间［（3.86±1.87）d vs （4.27±1.70）d，t=2.194，P=0.028］、首次排气时间［2.0（1.0）d vs 3.0（1.0）d，U=2.022，P=0.043］、术后住院时间［9.5（2.0）d vs 10.0（4.0）d，U=2.790，P=0.005］、总住院时间［14.0（4.0）d vs 15.0（6.0）d，U=2.574，P=0.010］和感染性并发症发生率（11.3% vs 23.2%，P=0.008）方面差异有统计学意义。两组的术中输血发生率、中转开腹率、淋巴结清扫数目、二次手术发生率差异无统计学意义（P＞0.05）。亚组分析显示，年龄<65岁、女性、BMI为18.5~23.9 kg/m2、接受直肠癌根治术的患者是机器人手术的最佳获益人群。结论 机器人手术在术后恢复方面和感染性并发症发生率方面优于腹腔镜手术，建议术者在开展机器人手术的前、中期，对年龄＜65岁、女性、BMI为18.5~23.9 kg/m2患者可优先考虑行机器人手术。
Abstract:Objective To compare the impact of robotic-assisted versus laparoscopic-assisted radical resection for colorectal cancer on perioperative outcomes using propensity score matching（PSM），and to explore the optimal patient population for robotic surgery during its initial and intermediate stages of implementation. Methods A retrospective analysis was conducted on patients who underwent radical resection for colorectal cancer at the Second Affiliated Hospital of Chongqing Medical University from January 2022 to December 2023. PSM was performed based on patients' sex，age，body mass index（BMI）， and surgical site. The primary outcomes were short-term postoperative results（reoperation rate，time to first flatus，time to first liquid intake，postoperative hospital stay，and total hospital stay）in the matched cohort. Secondary outcomes included intraoperative conditions（operation duration，estimated blood loss，intraoperative transfusion rate，conversion to open surgery，and number of lymph nodes dissected）and postoperative infectious complication rates.Results A total of 1 031 patients were included. After 1∶1 PSM between the robotic group （n= 147）and the laparoscopic group（n=884），142 matched pairs were retained. In the matched cohort，the laparoscopic group had a shorter operation time than the robotic group［179.48（69.88）min vs 237.98（82.27）min，U=6.849，P<0.01］. Significant differences were observed between the robotic and laparoscopic groups in estimated blood loss［50（20）mL vs 50（30）mL，U=2.746，P=0.006］，time to first liquid intake［（3.86±1.87）d vs（4.27±1.70）d，t=2.194，P=0.028］， time to first flatus［2.0（1.0）d vs 3.0（1.0）d，U=2.022，P=0.043］，postoperative hospital stay［9.5（2.0）d vs 10.0（4.0）d， U=2.790，P=0.005］，total hospital stay［14.0（4.0）d vs 15.0（6.0）d，U=2.574，P=0.010］，and infectious complication rates（11.3% vs 23.2%，P=0.008）. No significant differences were found in intraoperative transfusion rates，conversion to open surgery，number of lymph nodes harvested，or reoperation rates（P>0.05）. Subgroup analysis indicated that patients aged <65 years，female，with a BMI of 18.5 to 23.9 kg/m2，and those undergoing radical rectal resection were the optimal beneficiaries of robotic surgery.Conclusion Robotic surgery demonstrates advantages over laparoscopic surgery in postoperative recovery and infectious complication rates. Surgeons in the early and intermediate stages of robotic surgery adoption may prioritize patients aged <65 years，female，and with a BMI of 18.5 to 23.9 kg/m2 for robotic-assisted procedures.
keywords: Colorectal cancer Radical resection Robotic⁃assisted Laparoscopic⁃assisted Propensity score matching
文章编号： 中图分类号：R735.3 文献标志码：A
基金项目:
附件
| 作者 | 单位 |
| 李航 | 1. 重庆医科大学附属第二医院手术室,重庆 400010 |
| 顾海涛 | 2. 重庆医科大学附属第二医院胃肠外科,重庆 400010 |
| 李冬雪 | 1. 重庆医科大学附属第二医院手术室,重庆 400010 |
| 肖敏凤 | 3. 西安医学院护理学院, 陕西 西安 710021 |
| Author Name | Affiliation |
| LI Hang*，GU Haitao，LI Dongxue，XIAO Minfeng | *Department of Operating Room,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China |
引用文本：
李航,顾海涛,李冬雪,等.机器人辅助下行结直肠癌根治术最佳获益人群特征[J].中国临床研究,2025,38(7):1015-1019,1025.
李航,顾海涛,李冬雪,等.机器人辅助下行结直肠癌根治术最佳获益人群特征[J].中国临床研究,2025,38(7):1015-1019,1025.