机器人对比腹腔镜右半结肠切除结局单中心回顾性研究

Robotic versus Laparoscopic Right Hemicolectomy: A Single-Center Retrospective Study on Surgical Outcomes

摘要: 目的：本研究旨在通过对比机器人辅助与腹腔镜右半结肠切除术的临床疗效，探讨机器人手术在围术期管理、术后恢复及卫生经济学方面的综合价值。方法：回顾性纳入2013年3月至2024年10月青岛大学附属医院胃肠外科接受右半结肠癌根治术的522例患者，其中机器人组95例，腹腔镜组427例。所有患者均遵循加速康复外科(ERAS)管理路径及全结肠系膜切除(CME)原则。通过倾向性评分匹配法(PSM)消除基线差异后，比较两组手术时间、出血量、淋巴结清扫数目、术后恢复指标及医疗费用。结果：匹配后(机器人组83例，腹腔镜组272例)，患者在手术时间(机器人：176.18 ± 49.33 min vs 腹腔镜：213.71 ± 56.40 min，P < 0.001)、术中出血量(机器人：30 mL vs 腹腔镜：50 mL，P < 0.001)方面，机器人组显著优于腹腔镜组，且机器人组淋巴结清扫数目更多(24.77 ± 9.74枚 vs 21.89 ± 9.66枚，P = 0.018)。机器人组患者术后首次排气(2.34天 vs 3.02天)及排便时间(3.28天 vs 4.13天)均显著缩短(P < 0.001)。此外，机器人组患者住院费用较高(78,716元 vs 63,099元，P < 0.001)，但术后住院时间略短(7 [6~7]天 vs 7 [6~8]天，P = 0.030)。两组并发症发生率(18.1% vs 22.1%)相似。结论：机器人右半结肠切除术通过精准操作提升手术效率，促进术后胃肠功能恢复，但需权衡其经济成本。

Abstract: Objective: This study aims to compare the clinical efficacy between robotic-assisted and laparoscopic right hemicolectomy, evaluating the comprehensive value of robotic surgery in perioperative management, postoperative recovery, and health economics. Methods: This retrospective study enrolled 522 patients who underwent radical right hemicolectomy for colon cancer at the Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, between March 2013 and October 2024. The cohort comprised 95 robotic-assisted (RRC) and 427 laparoscopic (LRC) cases. All procedures followed enhanced recovery after surgery (ERAS) protocols and complete mesocolic excision (CME) principles. After propensity score matching (PSM) to balance baseline characteristics, intergroup comparisons were performed for operative time, intraoperative blood loss, lymph node yield, postoperative recovery parameters, and healthcare costs. Results: After matching (83 robotic cases vs. 272 laparoscopic cases), the robotic group showed significant advantages in operative time (robotic: 176.18 ± 49.33 min vs. laparoscopic: 213.71 ± 56.40 min, P < 0.001) and intraoperative blood loss (robotic: 30 mL vs. laparoscopic: 50 mL, P < 0.001). Additionally, the robotic group had a higher lymph node yield (24.77 ± 9.74 vs. 21.89 ± 9.66, P = 0.018). Postoperative recovery was faster in the robotic group, with shorter time to first flatus (2.34 days vs. 3.02 days, P < 0.001) and first defecation (3.28 days vs. 4.13 days, P < 0.001). Although hospitalization costs were higher in the robotic group (¥78,716 vs. ¥63,099, P < 0.001), postoperative hospital stay was slightly reduced (7 [6~7] days vs. 7 [6~8] days, P = 0.030). The complication rates were similar between the two groups (18.1% vs. 22.1%). Conclusion: Robotic right hemicolectomy improves surgical efficiency through precise manipulation and promotes postoperative gastrointestinal function recovery, though its economic costs require careful consideration.