机器人手术在复杂胆道结石治疗中应用效果的单中心回顾性对比研究

Robotic surgery for complex bile duct stones: a retrospective single-center comparative study

摘要:

背景与目的 复杂胆道结石常伴有肝门区粘连、解剖紊乱、胆道变异及胆道瘘，传统腹腔镜手术在此类病例中常需中转开腹，术后并发症发生风险较高。机器人系统具备高清三维视野和灵活操作优势，有望改善手术安全性与疗效。本研究旨在比较机器人手术与腹腔镜手术治疗复杂胆道结石的临床效果。方法 回顾性分析2023年1月—2025年1月于福州大学附属省立医院接受微创手术的145例复杂胆道结石患者，其中机器人组62例，腹腔镜组83例。比较两组患者术中情况、术后并发症及恢复情况，并随访评估结石复发。结果 两组患者基线资料差异无统计学意义（均P>0.05）。机器人组无中转开腹，而腹腔镜组中转率为7.2%，差异有统计学意义（P=0.038）。机器人组术后并发症发生率为1.6%，腹腔镜组为10.7%，差异有统计学意义（P=0.044）。机器人组术后首次进食、排气及住院时间均明显早于腹腔镜组（均P<0.05）。随访至2025年6月，两组均未见结石复发。结论 机器人手术在复杂胆道结石治疗中安全可行，可显著降低中转开腹率和并发症发生率，加快术后康复，具有推广应用价值。

Abstract:

Background and Aims Complex biliary stones are often accompanied by hilar adhesions, distorted anatomy, biliary variations, or biliary-enteric fistulas. Conventional laparoscopic surgery is limited in such settings, with high conversion and complication rates. Robotic surgical systems provide high-definition 3D vision and enhanced dexterity, potentially improving surgical outcomes. This study compared the clinical efficacy of robotic vs. laparoscopic surgery for complex biliary stones.Methods A retrospective analysis was performed on 145 patients with complex biliary stones who underwent minimally invasive surgery at Fujian Provincial Hospital, Fuzhou University, from January 2023 to January 2025. Patients were divided into a robotic group (n=62) and a laparoscopic group (n=83). Intraoperative outcomes, postoperative complications, and recovery parameters were compared. Stone recurrence was assessed during follow-up.Results Baseline characteristics were comparable between groups (all P>0.05). The conversion rate was 0 in the robotic group vs. 7.2% in the laparoscopic group (P=0.038). The postoperative complication rate was significantly lower in the robotic group (1.6% vs. 10.7%, P=0.044). Time to first oral intake, first flatus, and postoperative hospital stay were all shorter in the robotic group (all P<0.05). No stone recurrence was observed in either group during follow-up until June 2025.Conclusion Robotic surgery is a safe and feasible approach for complex biliary stones, offering reduced conversion and complication rates and faster recovery compared with laparoscopy. It holds promise for wider clinical application in complex biliary disease.