| BackgroundCervical cancer is the most common gynecological malignant tumor.The high incidence age of carcinoma in situ is 30-35 years old,and the age of invasive cancer is 45-55 years old.In recent years,its incidence has tended to be younger.Early cervical cancer often has no obvious symptoms and signs.The cervix can be smooth or difficult to distinguish from cervical columnar epithelium.Symptoms such as contact bleeding and vaginal discharge can occur with the development of the lesion.Surgery is the main treatment for patients with early cervical cancer,and the comprehensive treatment for patients with advanced cervical cancer is radiotherapy and chemotherapy.Radical resection of cervical cancer,that is,extensive hysterectomy combined with pelvic lymph node dissection,is the first-choice treatment option for early cervical cancer,and it is very important to the patient’s prognosis.At present,there are various surgical methods for completing radical cervical cancer surgery,including vaginal surgery,open surgery,traditional laparoscopic surgery,and robotic laparoscopic surgery.The use of traditional laparoscopic surgery is limited due to the lack of flexibility of its instruments,two-dimensional planar imaging,reverse operation,and long learning curve.With the continuous development of minimally invasive technology,in order to overcome these limitations,the Da Vinci robotic surgery system has been developed and created.In 2005,the Da Vinci robot was approved by the US FDA for gynecological surgery.The domestic introduction of the system was relatively late.As an emerging surgical system,its clinical application has not been long.Research on the safety and effectiveness of its application in radical cervical cancer surgery Few,long-term follow-up data research is relatively lacking.ObjectiveComparing the clinical data of robot-assisted laparoscopic surgery and traditional laparoscopic surgery for the treatment of early cervical cancer,explore the safety,feasibility,advantages and disadvantages and application value of robot-assisted laparoscopic radical resection of cervical cancer.MethodUsing retrospective analysis method,the clinical case data of 731 patients with cervical cancer who underwent radical cervical cancer surgery in the First Affiliated Hospital of Zhengzhou University from November 2014 to June 2020 were selected for analysis,and they were divided into two groups according to different surgical methods.,Including 358 cases in the robotic group and 373 cases in the laparoscopic group.The general conditions of the two groups were statistically analyzed:age,body mass index(BMI),history of abdominal surgery,number of preoperative conization cases,clinical stage,pathological type,tumor diameter,number of postoperative adjuvant treatment cases;perioperative related indicators:Operation time,intraoperative blood loss,intraoperative blood transfusion,anal exhaust time,indwelling drainage tube time,postoperative indwelling catheter time,postoperative hospital stay,hospitalization expenses;medical examination results:number of lymph nodes removed,lymph nodes detected The number of positive cases,the number of vascular invasion,and the number of poorly differentiated tumors.Intraoperative complications,postoperative complications and prognosis.The clinical data was statistically analyzed by SPSS21.0 software,the independent sample t test was used to analyze and compare the measurement data conforming to the normal distribution,and the chi-square test was used to analyze and compare the count data.The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.The survival rate of the two groups was compared by log-rank test.The difference is statistically significant when P<0.05.Result1.Comparison of the general clinical conditions of the two groups of patients,the robot group compared with the laparoscopic group,the average age,body mass index(BMI),number of cases of abdominal surgery history,tumor diameter(imaging),number of preoperative conization cases,clinical The stage,pathological type,and the number of postoperative adjuvant treatment cases were compared,and the difference was not statistically significant(P>0.05).2.There was no conversion to laparotomy during operation in both groups.Comparison of robot group and laparoscopic group during perioperative period:postoperative anal exhaust time[(2.7±0.7)d vs(2.5±0.6)d],indwelling Urinary catheter time[(21.1±14.4)d vs(17.7±11.2)d],postoperative hospital stay[(10.6±4.8)d vs(11.0±4.4)d],the difference was not statistically significant(P>0.05).The operation time of the robot group was shorter than that of the laparoscopic group,[(170.2±54.6)min vs(205.5±43.6)min,P=0.017],the difference was statistically significant;the intraoperative blood loss of the robot group was less than that of the laparoscopic group,[(93.8±42.6)ml vs(127.2±100.1)ml,P=0.027],the difference was statistically significant;the indwelling drainage tube in the robot group was longer than that in the laparoscopic group,[(6.3±3.7)d vs(4.9±2.4)d,P=0.000],the difference was statistically significant;the cost of hospitalization in the robotic group was more than that of the traditional laparoscopic group,[(54606.1±9868.3)(?) vs(35088.28±6730.87)(?),P=0.000],the difference was statistically significant.3.Intraoperative complications(ureter injury,bladder injury,vascular injury,nerve injury,bowel injury)in the robotic group were lower than those in the laparoscopic group[7(2.0%)vs 24(5.4%),P=0.003],of which intraoperative The number of vascular injuries was lower than that in the laparoscopic group[3(0.8%)vs 13(3.5%),P=0.014],and the difference was statistically significant.The overall postoperative complications(lymphatic fistula,lymphatic retention cyst,lymphedema,deep vein thrombosis,urinary retention,postoperative infection,pulmonary embolism,intestinal obstruction,abdominal wall incisional hernia,ureteral fistula or vesicovaginal fistula)were compared between the two groups[72(20.1%)vs 85(22.8%),P=0.188],the difference was not statistically significant;the incidence of postoperative lymphatic fistula in the robot group(25/358,7.0%)was higher than that of the laparoscopic group(10/373,2.7%)),the difference was statistically significant(P<0.05).The incidence of postoperative urinary retention in the robot group(7/358,2.0%)was lower than that of the laparoscopic group(24/373,6.4%),and the difference was statistically significant(P<0.05).4.Comparing the disease examination between the robot group and the laparoscopic group,the average number of lymph nodes removed[(19.8±9.4)vs(20.6±9.6)],positive lymph nodes were detected[66(18.4%)cases vs 71(19.0%))Cases],vascular invasion[71(19.8%)cases vs 60(16.1%)cases],poorly differentiated tumors[33(9.2%)cases vs 29(7.8%)cases],the difference was not statistically significant(P>0.05);the follow-up time of the robot group is 6-65 months,the median follow-up time is 29 months,the cumulative survival rate is 90.9%,the follow-up time of the laparoscopic group is 6-67 months,the median follow-up time is 30 Months,the cumulative survival rate was 83.0%.There was no statistically significant difference in the cumulative survival rate between the two groups(P>0.05).Conclusion1.Compared with the traditional laparoscopic group,the robot group has the advantages of shorter operation time,less intraoperative bleeding,intraoperative complications and postoperative urinary retention than the laparoscopic group.It is a better operation for patients with early cervical cancer Treatment options.2.Compared with traditional laparoscopy,robotic laparoscopy has higher hospitalization costs and a higher incidence of postoperative lymphatic fistula.3.Robotic laparoscopic surgery for early cervical cancer has the same short-term curative effect as traditional laparoscopy,and the long-term curative effect needs further follow-up. |
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