【摘要】 目的比较第四代达芬奇机器人Xi系统辅助单孔和多孔腹腔镜治疗妇科良性疾病围手术期效果。方法回顾性分析武汉大学中南医院妇科2020年1—12月因良性疾病行第四代达芬奇机器人Xi系统操作手术患者病历信息,其中机器人辅助单孔腹腔镜(robotic laparo-endoscopic single site surgery,R-LESS)56例,机器人辅助多孔腹腔镜(robotic laparo-endoscopic multiple site surgery,R-LEMS)70例。分析其手术时间、术中估计出血量、总住院时间、术后尿管拔除时间、术后引流管拔除时间、术前与术后血红蛋白差值、术后1d视觉模拟评分法(visual analogue scale,VAS)疼痛评分、是否输血、术后并发症发生率,并进行比较。结果与R-LEMS相比,R-LESS组出血量减少[(66.79±49.00)mL vs.(83.43±106.55)mL]、住院时间缩短[(7.25±1.43)d vs.(9.20±2.37)d],差异具有统计学意义(P<0.05);手术时间[(214.11±68.24)min vs.(231.27±85.10)min]、术后尿管拔除时间[(1.21±0.73)d vs.(1.58±1.59)d]、引流管拔除时间[(2.61±1.13)d vs.(2.67±0.84)d)]、术前术后(1 d和3d)血红蛋白差值[(19.93±9.39)g/L vs.(17.28±9.82)g/L;(18.21±10.21)g/L vs.(14.96±11.56 g/L)]、术后24h VAS疼痛评分[(0.95±0.23)vs.(0.83±0.38)]、术后并发症发生率(3.6%vs. 5.7%)两组比较差异无统计学意义(P>0.05)。结论 R-LESS用于妇科良性疾病具有安全性和可行性,与R-LEMS相比,出血量少,住院时间缩短,但仍需大样本前瞻性研究予以进一步证实。更多还原

【Abstract】 Objective To compare the perioperative outcomes of benign gynecological diseases by the fourth generation of Da Vinci robotic trans-umbilical single-site laparoscopy and conventional multiple-site laparoscopy.Methods The data of patients who underwent the fourth-generation Da Vinci Xi robotic laparoscopic surgery for benign diseases between January 2020 and December 2020 in Department of Gynecology,Zhongnan Hospital of Wuhan University were retrospectively analyzed,including 56 cases with robotic laparo-endoscopic single site surgery(R-LESS)and 70 cases with robotic laparo-endoscopic multiple sites surgery(R-LEMS). The operation time,estimated blood loss,hospitalization time,removal time of drainage tube after surgery,catheter removal time after surgery,hemoglobin difference between preoperation and after surgery,postoperative 24 h visual analogue scale(VAS)score,transfusion or not,and incidence of postoperative complications were analyzed.Results Compared with R-LEMS,the blood loss was decreased(66.79±49.00 vs. 83.43±106.55 mL),and the length of hospital stay was shortened[(7.25±1.43)d vs.(9.20±2.37)d]in R-LESS group,the difference of which was statistically significant(P<0.05). The operation time[(214.11±68.24)min vs.(231.27±85.10)min],the catheter removal time after surgery[(1.21±0.73)d vs.(1.58±1.59)d],and the drainage tube removal time[(2.61±1.13)d vs.(2.67±0.84)d],preoperative and postoperative hemoglobin difference(1 day/3 days)[(19.93±9.39)g/L vs.(17.28±9.82)g/L;(18.21±10.21)g/L vs.(14.96±11.56)g/L],postoperative 24 hVAS score[(0.95±0.23)vs.(0.83±0.38)]and postoperative complication rate(3.6% vs. 5.7%)showed no significant difference compared with R-LEMS(P>0.05).Conclusion R-LESS is safe and feasible for benign gynecological diseases. Compared with R-LEMS,it has less blood loss and shorter hospital stay,but it still needs to be further confirmed in a large sample prospective study.更多还原