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目的:比较机器人辅助腹腔镜与普通腹腔镜处理腹膜后肿瘤的手术安全性和临床疗效。方法:回顾性分析2010年10月~2016年10月期间在我院接受腹腔镜手术治疗的腹膜后肿瘤患者的临床资料,其中接受机器人辅助腹腔镜手术的患者共计有20例,接受普通腹腔镜手术的患者共计有47例。收集统计所有患者临床资料,按照1∶1比例精确匹配20例接受普通腹腔镜腹膜后肿瘤切除术的患者组成对照组,主要匹配参数为患者的肿瘤良恶性、肿瘤大小以及肿瘤位置。比较两组患者基本特征、围手术期资料、术中与术后并发症发生情况及术后随访结果,并将两组患者合并一起,统计分析手术临床效果与肿瘤位置、肿瘤最大直径的相关性。结果:匹配性分析显示两组患者在性别构成(P=0.519)、年龄(P=0.110)、体质指数(P=0.360)、术前ASA评分(P=0.677)及肿瘤最大直径(P=0.660)等方面的差异均无统计学意义。手术安全性及手术疗效指标:手术转开放率(P=0.598)、手术时间(P=0.777)、术中出血量(P=0.450)、术后引流时间(P=0.508)、术后住院天数(P=0.375)、术中并发症(P=0.661)及Clavien评分(P=0.056)差异均无统计学意义。肿瘤位置与手术时间的相关系数r=0.331,有相关性(P=0.037);肿瘤位置与手术后住院天数的相关系数r=0.010,有相关性(P=0.010)。结论:腹膜后肿瘤的切除的难易程度与肿瘤的位置显著相关;机器人辅助腹腔镜下腹膜后肿瘤切除是安全、有效、可行的,与普通腹腔镜相比能达到相同的手术效果。
OBJECTIVE: To compare the safety and clinical efficacy of robot-assisted laparoscopy with laparoscopy in the treatment of retroperitoneal neoplasms. Methods: The clinical data of patients with retroperitoneal tumors undergoing laparoscopic surgery in our hospital from October 2010 to October 2016 were analyzed retrospectively. Twenty patients underwent robot assisted laparoscopic surgery, of which 20 received general laparoscopy A total of 47 patients with surgery. The clinical data of all patients were collected. According to the ratio of 1: 1, 20 patients with normal laparoscopic resection of retroperitoneum were matched exactly. The main matching parameters were benign and malignant tumors, tumor size and tumor location. The basic characteristics, perioperative data, intraoperative and postoperative complications and postoperative follow-up results were compared between the two groups, and the two groups were combined to statistically analyze the correlation between the clinical effect of the operation and the location of the tumor and the maximum diameter of the tumor . Results: The matching analysis showed that there were significant differences in gender composition (P = 0.519), age (P = 0.110), body mass index (P = 0.360), preoperative ASA score (P = 0.677) ) And other differences were not statistically significant. The safety of operation and the curative effect index of operation: the rate of open operation (P = 0.598), operation time (P = 0.777), intraoperative blood loss (P = 0.450), postoperative drainage time (P = 0.375), intraoperative complications (P = 0.661) and Clavien score (P = 0.056). There was no significant difference between the two groups. The correlation coefficient between tumor location and operation time was 0.331 (P = 0.037). Correlation coefficient between tumor location and hospitalization days after operation was 0.010 (P = 0.010). Conclusions: The difficulty of resection of retroperitoneal tumor is significantly related to the location of tumor. Robot assisted laparoscopic retroperitoneal tumor resection is safe, effective and feasible, and can achieve the same surgical effect compared with normal laparoscopy.