摘要
目的:探讨机器人辅助与腹腔镜肝切除术治疗肝内胆管结石的安全性及治疗效果。方法:回顾性分析2021年2月—2024年8月于昆明医科大学第二附属医院行机器人辅助或腹腔镜肝切除术的肝内胆管结石患者的临床资料,根据手术方式分为腹腔镜组与机器人组,经过倾向评分匹配1∶2匹配后,腹腔镜组35例,机器人组18例。比较两组患者的围手术期指标、实验室指标及术后并发症发生情况。结果:机器人组的术中出血量、肝门阻断次数及肝门阻断时间均优于腹腔镜组,住院总费用高于腹腔镜组(P<0.05)。机器人组术后1 d的ALT、AST水平低于腹腔镜组(P<0.05)。两组在手术时间、术中输血率、中转开腹率、术后住院时间、其他实验室指标及术后并发症发生率方面,差异无统计学意义(P>0.05)。结论:与腹腔镜肝切除术相比,机器人辅助肝切除术在治疗肝内胆管结石方面具有优势,其术中出血量更少、肝门阻断次数更少、阻断时间更短,有助于促进术后肝功能恢复,围手术期安全性和治疗效果更优。
Objective:To evaluate the safety and therapeutic efficacy of robot-assisted versus laparoscopic hepatectomy for intrahepatic bile duct stone.Methods:Clinical data of patients with intrahepatic biliary stone who underwent robot-assisted or laparoscopic hepatectomy at the Second Affiliated Hospital of Kunming Medical University from February 2021 to August 2024 were retrospectively analyzed.Patients were divided into the laparoscopic group and the robotic group based on surgical approach.After 1∶2 propensity score matching,the laparoscopic group included 35 patients,while the robotic group included 18 patients.Perioperative indicators,laboratory parameters,and postoperative complications were compared between the two groups.Results:The robotic group had less intraoperative blood loss,fewer hepatic portal occlusions,and shorter hepatic portal occlusion times than the laparoscopic group,but higher total hospital costs(P<0.05).On postoperative day 1,the robotic group showed lower levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)than the laparoscopic group(P<0.05).No statistically significant differences were observed between the two groups in terms of operative time,intraoperative transfusion rate,conversion to open surgery rate,postoperative length of hospital stay,other laboratory indicators,or postoperative complication rates(P>0.05).Conclusion:Robot-assisted hepatectomy has certain advantages over laparoscopic hepatectomy in the treatment of intrahepatic bile duct stones,with significantly reduced intraoperative blood loss,fewer hepatic portal occlusions,and shorter occlusions time,which contributes to improved postoperative liver function recovery,along with enhanced perioperative safety and superior therapeutic outcomes.
作者
李国旺
李婧
康强
杨晨
柯阳
李越华
LI Guowang;LI Jing;KANG Qiang;YANG Chen;KE Yang;LI Yuehua(Ward 2,Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)
基金
国家自然科学基金(82460461)
云南省中青年学术和技术带头人后备人才项目(202205AC160063)。
关键词
机器人辅助手术
肝内胆管结石
肝切除术
安全性
疗效
Robot-assisted Surgery
Intrahepatic Bile Duct Stone
Hepatectomy
Safety
Efficacy
