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:

背景与目的 肝切除术作为肝血管瘤的重要治疗手段，已从传统的开腹手术逐渐转为腹腔镜手术和机器人辅助手术，但对于肝血管瘤，机器人辅助是否能比腹腔镜提供更好的治疗效果，目前尚未达成共识。因此，本研究评估和比较机器人辅助与腹腔镜肝切除术治疗肝血管瘤的临床疗效和安全性。方法 回顾性收集2021年2月—2024年7月在昆明医科大学第二附属医院肝胆胰外科因肝血管瘤行微创肝切除的184例手术患者的临床资料，其中，机器人组30例，腹腔镜组154例。使用患者基本情况、肿瘤特征、手术切除范围等基线资料对病例进行1∶2的倾向评分匹配法（PSM），比较PSM后两组的术中、术后相关指标。结果 按1∶2进行PSM后机器人组患者24例，腹腔镜组患者48例，两组术前指标平衡良好（受试者工作特征曲线下面积为0.588）。机器人组的手术时间（138 min vs. 168 min，P=0.024）和肝门阻断时间（25 min vs. 45 min，P<0.001）明显短于腹腔镜组，术后第1、3天白蛋白水平均高于腹腔镜组，术后第1、3天转氨酶均低于腹腔镜组（均P<0.05），但机器人组住院费用高于腹腔镜组（74 746元vs. 49 644元，P<0.001）。两组在术中出血量、术中输血率、中转开腹率、术后住院时间、术后并发症发生率及并发症严重程度方面差异均无统计学意义（均P>0.05）。结论 对于适宜的肝血管瘤病例，机器人辅助腹腔镜肝切除术治疗是安全可行的，与传统腹腔镜相比，其缩短了手术时间及肝门阻断时间，减轻了手术对术后肝功能的影响，然而治疗费用也更高，需结合患者实际需求合理选用。

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.