【摘要】 目的回顾大量临床经验客观描述机器人手术在超重和肥胖妇科恶性肿瘤患者中的围手术期指标,兼顾疗效和卫生经济学价值评估,从而更好地指导复杂患者的临床手术方式选择。方法回顾性分析2012年2月至2020年6月解放军总医院第一医学中心妇科收治的行手术治疗的1 716例妇科恶性肿瘤患者临床资料,应用统计软件SPSS24.0比较行不同手术方式的超重和肥胖患者的手术时间(机器人手术包含装机时间)、术中出血量、淋巴结切除数目、术后住院时间、术后排气时间、住院费用和手术并发症情况。结果本研究纳入的1 716例妇科恶性肿瘤患者中超重621例,机器人手术患者的术中出血量(127.32±120.37)ml(P<0.001)、淋巴结切除数目(26.38±12.07)枚(P<0.001)、术后排气时间(1.98±0.60)d(P=0.001)、住院费用(68 342.79±13 041.57)元(P<0.001)、手术时间(199.63±56.97)min(P=0.350)、术后住院时间(11.12±4.25)d(P=0.270)。肥胖患者113例,机器人手术患者的术中出血量(119.55±89.83)ml(P<0.001)、淋巴结切除数目(26.91±11.12)枚(P=0.020)、术后排气时间(1.96±0.56)d(P=0.003)、住院费用(65 329.79±15 360.30)元(P=0.090),手术时间(206.64±66.62)min(P=0.690)、术后住院时间(10.54±4.57)d(P=0.430)。按病种分类,超重宫颈癌患者行机器人手术的术中出血量(130.95±118.06)ml(P<0.001),超重卵巢癌患者行机器人、腹腔镜、开腹手术的并发症发生率差异无统计学意义(P=0.250)。结论机器人手术治疗超重妇科恶性肿瘤患者明显减少术中出血量、降低中转开腹率,增加淋巴结切除数目,缩短术后排气时间,实现加速康复外科理念。而对于肥胖患者,应用达芬奇机器人手术同样具有上述优势,且不增加住院费用,保证安全性的同时具有潜在卫生经济价值。更多还原

【Abstract】 Objective Review a large number of clinical experiences and objectively describe the peroperative indicators of robotic surgery in overweight and obese patients, taking into account the evaluation of efficacy and health economic value, so as to better guide the selection of surgical procedures for complex patients. Methods From Feb. 2012 to Jun. 2020, 1 716 patients with gynecological malignant tumor in our department were selected, of which all underwent surgery.The basic information, data of operation index, tumor pathological characteristic were collected and analyzed with SPSS24.0 software. Operation index comprises of surgical methods, operation time(robot system including the installed time), intraoperative blood loss, number of lymph node excision, postoperative hospitalization days, exhaust time, hospitalization expenses and surgical complications.Results Among the 1 716 patients with gynecologicat malignancies included in this study, 621 patients were overweight. The intraoperative blood loss of patients treated with da Vinci robot system was(127.32±120.37) ml(P<0.001); the number of lymph nodes resection was(26.38±12.07)(P<0.001); Exhaust time(1.98±0.60)days(P=0.001); Hospitalization expenses were(68 342.79±13 041.57) CNY(P<0.001),Operation time(199.63±56.97) min(P=0.350),Postoperative hospitalization(11.12±4.25) days(P=0.270).In addition, 113 obese patients in this study were treated with da Vinci robot system, and the amount of intraoperative blood loss was(119. 55 ± 89. 83)ml(P< 0. 001),Number of lymph nodes removed(26. 91 ± 11. 12)(P= 0. 020), Exhaust time(1. 96 ±0. 56)days(P=0. 003),Hospital expenses were(65 329. 79 ±15 360. 30) CNY(P= 0. 090),Operation time(206. 64 ±66. 62) min(P=0. 690),Postoperative hospitalization time(10. 54 ±4. 57) days(P=0. 430). Theintraoperative blood loss in patients with overweight cervical cancer was(130. 95 ± 118. 06) ml(P< 0. 001).There was no significant difference in the incidence of complications between robot, laparoscopic and opensurgery in overweight patients with ovarian cancer(P=0. 250).Conclusions For overweight patients, the daVinci robot system not only significantly reduce the intraoperative blood loss and conversion rate, but alsoincrease the number of lymph node resection. It shorten the exhaust time of patients and realize the concept ofrapid rehabilitation surgery. For obese patients,the da Vinci robot system doesn′t increase hospitalization costssimultaneously. Therefore,the da Vinci robot system can ensure security along with health economics value.更多还原