| Objective To investigate the short-term effect of Da Vinci robot in the radical resection of distal gastric cancer and its influence on the immune function of patients.Methods Retrospective cohort study was used.Data of patients undergoing radical resection of distal gastric cancer in Chifeng hospital from August 2018 to December2020 were collected.Among them,20 patients who performed the robot assisted operation were set as robot group,35 patients who underwent laparoscopic assisted operation were set as laparoscopy group,35 patients who underwent open surgery were set as open group.The short-term efficacy index of three surgical methods was compared,including cross contrast of their effects on cellular immune function.Inspection method:T lymphocyte subsets in peripheral blood were detected by flow cytometry.Observation index:(1)The perioperative related indexes included operation time,Amount of bleeding during operation,number of lymph nodes dissected,first anal exhaust time after operation,abdominal drainage(1d,2d,3d,7d),Visual Analogue Scale(VAS)(24h,48h).(2)Complication rate;(3)Immune index.Results There was no difference in the general data of the robot group,laparoscopic group and open group.(1)The operation related indexes were as follows:firstly,compared with laparoscopic group,the operation time of robot group was longer(374.55±46.45 min vs 228.86±25.73min,t=15.018,P<0.05),and the bleeding amount was less(79.50±40.84 ml vs 114.00±62.74 ml,t=-2.202,P<0.05),and the number of lymph node cleaning was more(59.65±17.12 vs 50.94±12.09,t=2.203,P<0.05).Compared with laparoscopic group,the flow of abdominal cavity was less in the robot group on the first day,the second day and the third day after operation(t=-6.272,-6.916,-8.485,P<0.05).The flow rate of abdominal drainage on the 7th day after operation was similar to that of laparoscopic group(4.05±4.16 ml vs 5.06±3.85 ml,t=-0.906,P>0.05).There was no difference in the first anal exhaust time between the robot group and the laparoscopic group(2.90±0.91 days vs 2.69±0.76 days,t=0.936,P>0.05).The VAS score of 24 hours after operation and 48 hours after operation were the same in both groups(t=-0.295,-0.693,P>0.05).Secondly,compared with the open group,the operation time of the robot group was significantly prolonged(374.55±46.45 min vs188.57±30.50 min,t=17.925,P<0.05),the bleeding volume was significantly lower than that in the open abdominal group(79.50±40.84 ml vs 235.43±96.99 ml,t=-6.830,P<0.05),and the number of lymph nodes cleaning was more(59.65±17.12 vs41.51±15.03,t=4.092,P<0.05).The abdominal drainage volume of the robot group was less on the first day,the second day,the third day and the 7th day after the operation(t=-8.353,-8.230,-9.610,-5.270,P<0.05).The first anal exhaust time of the robot group was as same as that of the open group(2.90±0.91 days vs 2.71±0.89 days,t=0.736,P>0.05).The VAS score of 24 hours and 48 hours after operation were lower than that in the open abdominal group(t=-3.122,-3.496,P<0.05).(2)There was no significant difference in the complications among the three groups:[2(10%)vs 4(11.43%)vs 5(11.43%),x~2=0.032,P>0.05].(3)Immune index:firstly,the immune indexes of the robot group in the first day after operation were significantly worse than those in the third days before operation:CD4(36.20±4.14 vs 39.25±4.68,t=-3.681,P<0.05),CD8(22.85±4.19 vs 17.75±2.19,t=6.646,P<0.05),CD4/CD8(1.63±0.33 vs2.19±0.29,t=-7.446,P<0.05).The immune index of 7th day after operation was recovered to the level of 3th day before operation:CD4(41.55±4.63 vs 39.25±4.68,t=2.038,P>0.05),CD8(18.55±3.28 vs 17.75±2.19,t=1.479,P>0.05),CD4/CD8(2.29±0.44 vs 2.19±0.29,t=1.058,P>0.05).Secondly,the preoperative immune indexes of the three groups were consistent:CD4(39.25±4.68 vs 38.23±6.22 vs 38.29±6.37,F=0.215,P>0.05),CD8(17.75±2.19 vs 18.26±2.48 vs 18.31±2.07,F=0.441,P>0.05),CD4/CD8(2.19±0.29 vs 2.13±0.45 vs 2.13±0.34,F=0.261,P>0.05).Thirdly,among the immune indexes of robot group and laparoscopic group,CD4 index was slightly better than that of laparoscopic group,and the other indexes were approximately the same:CD4(36.20±4.14 vs 32.37±7.07,t=2.211,P<0.05),CD8(22.85±4.19 vs22.94±4.35,t=-0.077,P>0.05),CD4/CD8(1.63±0.33 vs 1.45±0.42,t=1.636,P>0.05).Fourthly,the immune indexes of the robot group were approximately the same as those in the laparoscopic group at 7 days after operation:CD4(41.55±4.63 vs 39.46±7.29,t=1.155,P>0.05),CD8(18.55±3.28 vs 19.14±3.93,t=-0.570,P>0.05),CD4/CD8(2.29±0.44 vs 2.13±0.55,t=1.157,P>0.05).Fifthly,the immune index of the robot group was better than that of the open group on the first day after operation:CD4(36.20±4.14 vs 29.03±5.36,t=5.162,P<0.05),CD8(22.85±4.19 vs 25.54±3.76,t=-2.449,P<0.05),CD4/CD8(1.63±0.33 vs 1.15±0.23,t=6.373,P<0.05).Sixthly,the immune indexes of the robot group were better than those in the open group at 7th day after operation:CD4(41.55±4.63 vs 33.71±5.73,t=5.216,P<0.05),CD8(18.55±3.28vs 21.06±3.93,t=-2.409,P<0.05),CD4/CD8(2.29±0.44 vs 1.64±0.39,t=5.649,P<0.05).Conclusion Compared with laparoscopy and laparotomy,Da Vinci robot has a longer operation time,but it does not increase the surgical complications,and has obvious advantages in protecting blood vessels and cleaning lymph nodes,and can reduce postoperative pain,which is conducive to postoperative recovery.In the inhibition of cellular immune function,robot is significantly lighter than open surgery,even slightly better than laparoscopy.The overall short-term effect of robotic surgery is excellent. |
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