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題名 | Robotic versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Comparison of Short-term Clinical Outcomes=低位直腸癌使用腹腔鏡或機器人輔助手術兩種不同手術方式進行“經肛門括約肌間分離手術”,其臨床和病理學上的分析和比較 |
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作者 | 陳嘉哲; 黃彥鈞; 郭立人; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 27:3 2016.09[民105.09] |
頁次 | 頁100-106 |
分類號 | 416.245 |
關鍵詞 | 機器人輔助手術; 經肛門括約肌間分離手術; 低位直腸癌; Intersphincteric resection; Laparoscopic surgery; Robotic surgery; |
語文 | 英文(English) |
中文摘要 | 目的“經肛門括約肌間分離手術"是提高“低位直腸癌"病人肛門保留的手術方式。本研究的目的,在比較腹腔鏡微創手術、或機器人輔助手術這兩種不同手術方式進行“經肛門括約肌間分離手術",其臨床上和病理學上的差異。方法自民國98年11月到民國103年4月,我們對106位接受“經肛門括約肌間分離手術"的患者進行回顧性的分析。其中包括了31位病人接受腹腔鏡微創手術,75位病人接受機器人輔助手術。臨床的資料,包括了病人的年齡,性別,臨床分期,手術時間,出血量,手術後臨床情況,和病理結果進行分析研究。結果在腹腔鏡組上,平均估計失血量是為110.3毫升(範圍,30-300毫升),在機器人輔助手術這組平均估計失血量是69.7ml(範圍,30-200毫升)。估計失血量在這兩組之間有顯著性的差異(p=0.004)。在腹腔鏡組平均手術時間為382.1分鐘(範圍,210-600分鐘),機器人輔助手術組為466.2分鐘(範圍285-720分鐘),平均手術時間在這兩組間有統計學上顯著差異(p<0.001)。在平均住院天數,手術後恢復正常飲食,及手術後腸胃道開始蠕動時間上,在腹腔鏡組和機器人輔助手術組兩組並無統計學上的差異(p=0.937,0149,0.071)。結論我們提出我們以微創手術治療低位直腸癌的經驗。根據我們目前的研究結果顯示,機器人直腸手術的臨床結果,不管在住院日數,手術併發症,腫瘤學上的分析,和轉換成其他方式手術的比率,都與腹腔鏡微創手術沒有明顯統計學上的差異,但仍需更多的前瞻性實驗設計,和更大量的資料統計,才能再做更進一步的臨床結果,甚至長時間腫瘤學上預後分析的結論。 |
英文摘要 | Purpose. The intersphincteric resection (ISR) technique has been employed to extend the opportunity for sphincter preservation in patients with low rectal cancer. The aim ofthis study was to compare the short-term outcomes forrobot-assisted and laparoscopic ISR for rectal cancer. Methods. One hundred and six patients with rectalcancer who underwent curative resection between November 2009 and April 2014 were included. Patients were classified into the laparoscopic group (n = 31), and the robotic group (n = 75). Data analyzed include estimated blood loss, operating time, time to first flatus passage, time to normal diet, length of hospital stay, histopathologic status including distal resection margin, status of circumferential resection margin (CRM), and number of lymph nodes harvested. Results. Analyses on clinical results revealed mean estimated blood loss of 110.3 ml (range, 30-300 ml) in the laparoscopic group, and 69.7 ml (range, 30-200 ml) in the robotic group, indicating statistically significant different (p = 0.004). The mean operating time was 382.1 minutes (range, 210-600 minutes) in the laparoscopic group, and 466.2 minutes (range, 285-720 minutes) in the robotic group, also showing statistically significant difference (p < 0.001). In contrast, there were no statistically significant differences in length of postoperative hospital stay, resumption of oral diet, and regaining of bowel peristalsis between these two operative procedures (p = 0.937, 0.149, and 0.071, respectively). Conclusions. The findings showed that robotic ISR, a minimally invasive approach for rectal cancer, has acceptable morbidity and mortality rates as well as reasonable oncological outcomes, but is currently too expensive with longer operating time compared with conventional laparoscopy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。