摘要
目的探讨“机器人”结直肠肿瘤经自然腔道取标本手术(R-CRC-NOSES)的可行性和安全性。方法采用描述性病例系列研究方法。纳入2013年3月至2022年3月期间全国12家医院的R-CRC-NOSES病例。回顾性收集患者一般资料、肿瘤根治性资料(淋巴结检出数、转移阳性淋巴结数以及阳性切缘情况等)和手术安全性资料(手术时间、术中出血量以及术后并发症情况等)。结果本研究共纳入有效病例983例。平均年龄(61.5±9.6)岁,平均BMI(22.8±6.7)kg/m^(2),4.8%的病例接受术前新辅助治疗,77.1%的病例采用经直肠取标本。肿瘤根治性资料显示:最大环周直径3 cm~5 cm比例占病例总数的64.1%,管状腺癌比例占病例总数的85.6%,T3和T4期比例占总病例数的76.2%,68.2%的病例检出淋巴结数目≥12枚,28.9%的病例有淋巴结转移;Ⅰ~Ⅲ期病例分别占5.6%,29.7%和64.7%,无环周切缘阳性。手术安全性资料显示:无中转开腹病例,平均手术时间为(172.9±55.2)min,平均术中出血量为(46.3±20.3)mL,平均术后首次排气时间(47.5±12.0)h,平均术后进食时间为(73.5±12.8)h,平均术后住院时间为(8.2±2.5)d,术后并发症总发生率为14.1%,非计划再手术比例为1.7%,围手术期无死亡病例,术后肛门功能障碍者占总数的1.3%,未发现阴道功能障碍者。结论R-CRC-NOSES具有良好的可行性和安全性,值得临床广泛推广应用。
ObjectiveTo assess the efficacy and safety of robotic natural orifice specimen extraction surgery (R-CRC-NOSES).MethodsThis descriptive case-series study identified patients who underwent R-CRC-NOSES from March 2013 to March 2022 in 12 tertiary hospitals in China. Data on patient characteristics, surgery characteristics, and oncology-related surgery outcomes were analyzed.ResultsA total of 983 patients were identified. Age at surgery were (61.5±9.6) years. Body mass index were(22.8±6.7)kg/m^(2). 4.8% of the patients received neoadjuvant chemoradiotherapy. 77.1% of the patients underwent rectal specimen extraction. Regarding oncology-related surgery outcomes, 64.1% patients had tumors 3 cm~5 cm in diameter;adenocarcinoma makes up of 85.6% of the study population;76.2% patients had T3/T4 disease;the proportion of harvested lymph nodes ≥12 was 68.2% while 28.9% patients had positive lymph node;stage I~Ⅲ disease were 5.6%, 29.7% and 64.7%, respectively;none of the patients had positive circumferential margins. Surgery characteristics are as follows: no patients transferred to open surgery, surgery time was (172.9±55.2) min;intraoperative bleeding was (46.3±20.3) mL;time to first flatus postoperative was (47.5±12.0) hours;time to first postoperative fluid diet was (73.5±12.8) hours;hospitalization time was (8.2±2.5) days with an overall complication rate of 14.1% and a reoperation rate of 1.7%;no death occurred;1.3% patients developed anal disorders and vaginal dysfunction was not observed.ConclusionR-CRC-NOSES has favourable efficacy and safety suggesting an alternative surgery modality.
作者
刘东宁
何国栋
姚宏亮
王锡山
王贵玉
熊德海
佘军军
胡军红
袁维堂
杨春康
蔡建春
韩方海
曾祥福
何鹏辉
叶善平
牛正川
刘奎杰
关旭
汤庆超
黄睿
时飞宇
连玉贵
官申
简锦亮
王振发
周声宁
赵书锋
韦烨
李太原
Dongning Liu;Guodong He;Hongliang Yao;Xishan Wang;Guiyu Wang;Dehai Xiong;Junjun She;Junhong Hu;Weitang Yuan;Chunkang Yang;Jianchun Cai;Fanghai Han;Xiangfu Zeng;Penghui He;Shanping Ye;Zhengchuan Niu;Kuijie Liu;Xu Guan;Qingchao Tang;Rui Huang;Feiyu Shi;Yugui Lian;Shen Guan;Jinliang Jian;Zhenfa Wang;Shenning Zhou;Shufeng Zhao;Ye Wei;Taiyuan Li(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032 China;Department of Gastrointestinal Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Colorectal Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Colorectal Cancer,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Gastrointestinal Surgery,Chongqing Three Gorges Central Hospital,Wanzhou 404000,China;Department of General Surgery,First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China;Department of Colorectal and Anal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Gastrointestinal Surgical Oncology,Fujian Tumor Hospital,Fuzhou 350014,China;Department of Gastrointestinal Surgery,Zhongshan Hospital of Xiamen University,Xiamen 361004,China;Department of Gastrointestinal Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Gastrointestinal Surgery,First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China)
出处
《中华结直肠疾病电子杂志》
2022年第6期474-481,共8页
Chinese Journal of Colorectal Diseases(Electronic Edition)
