中国普通外科杂志2025，Vol.34Issue(1)：70-78,9.DOI:10.7659/j.issn.1005-6947.240569
机器人辅助与腹腔镜肝切除术治疗肝血管瘤的安全性及疗效比较
Safety and efficacy of robotic-assisted vs.laparoscopic hepatectomy for the treatment of hepatic hemangiomas
摘要
Abstract
Background and Aims:Hepatectomy is an important treatment option for hepatic hemangioma,and the approach has gradually shifted from traditional open surgery to laparoscopic and robotic-assisted surgery.However,there is still no consensus on whether robotic assistance provides better treatment outcomes than laparoscopic surgery for hepatic hemangioma.Therefore,this study was performed to evaluate and compare the clinical efficacy and safety of robotic-assisted and laparoscopic hepatectomy for the treatment of hepatic hemangioma. Methods:The clinical data of 184 patients who underwent minimally invasive hepatectomy for hepatic hemangioma in the Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Kunming Medical University,between February 2021 and July 2024 were retrospectively collected.Among them,30 cases were in the robotic group,and 154 cases were in the laparoscopic group.Propensity score matching(PSM)was performed based on baseline data such as patient demographics,tumor characteristics,and surgical resection range,with a 1∶2 matching ratio.Intraoperative and postoperative outcomes were compared between the two groups after matching. Results:After 1∶2 PSM,24 patients were in the robotic group and 48 in the laparoscopic group.Preoperative variables were well balanced between the groups(area under the ROC curve was 0.588).The robotic group had significantly shorter operative time(138 min vs.168 min,P=0.024)and hepatic hilum blocking time(25 min vs.45 min,P＜0.001)compared to the laparoscopic group.Postoperative albumin levels on day 1 and day 3 were higher in the robotic group,while transaminase levels on postoperative day 1 and day 3 were lower(all P＜0.05).However,the hospitalization cost was higher in the robotic group than that in the laparoscopic group(74 746 yuan vs.49 644 yuan,P＜0.001).No significant differences were found between the groups in terms of intraoperative blood loss,intraoperative transfusion rate,open conversion rate,postoperative length of stay,and postoperative complication rates as well as complication severity(all P＞0.05). Conclusion:For suitable cases of hepatic hemangioma,robotic-assisted laparoscopic hepatectomy is a safe and feasible treatment option.Compared to traditional laparoscopic surgery,it reduces operative time and hepatic hilum blocking time,and minimizes the impact on postoperative liver function.However,the treatment cost is higher,and selection should be based on the patient's individual needs.关键词
肝肿瘤/血管瘤/肝切除术/机器人手术/腹腔镜Key words
Liver Neoplasms/Hemangioma/Hepatectomy/Robotic Surgical Procedures/Laparoscopes分类
医药卫生引用本文复制引用
姜改明,郑凯,李宇铠,李婧,康强,柯阳,李越华..机器人辅助与腹腔镜肝切除术治疗肝血管瘤的安全性及疗效比较[J].中国普通外科杂志,2025,34(1):70-78,9.基金项目
国家自然科学基金资助项目(82460461,82103173) （82460461,82103173）
云南省中青学术和技术带头人后备人才基金资助项目(202205AC160063) （202205AC160063）
云南省基础研究计划优秀青年基金资助项目(202401AW070003). （202401AW070003）
