英国良性上消化道科室中机器人对比腹腔镜抗反流与食管裂孔手术：一项四年观察性研究的围手术期结局
Robotic versus laparoscopic anti-reflux and hiatal surgery in a uk benign upper gi unit: perioperative outcomes in a four-year observational study.
文献信息
| PMID | 42766219 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jada Saunders |
| 作者单位 | Department of Upper GI Surgery, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom. jada.saunders@nhs.net. |
| 期刊 | Journal of robotic surgery |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 机器人胃底折叠术在英国迅速推广，然而来自常规良性上消化道（UGI）实践的可靠比较数据仍然有限。本研究比较了英国一家良性UGI科室中机器人胃底折叠术与腹腔镜胃底折叠术的围手术期结局。
方法： 这项回顾性观察性研究纳入了2022年2月至2026年1月期间连续接受择期腹腔镜或机器人抗反流或食管裂孔手术的成人。主要结局为总手术时间。次要结局包括住院时间、当日出院、并发症、30天再入院、30天重返手术室、后续再次胃底折叠术以及早期临床记录的复发。
结果： 共纳入100例患者：57例机器人手术和43例腹腔镜手术。机器人手术中修正手术更为常见（33.3%对11.6%；p=0.006）。总体而言，机器人手术的中位手术时间更短（88对120分钟；p=0.017），当日出院率更高（63.2%对27.9%）。在排除手术量最高的机器人外科医生后，机器人中位手术时间仍比腹腔镜短27分钟（93对120分钟），但差异不再具有统计学显著性（p=0.16）。在76例初次手术中，机器人手术与更短的非校正手术时间相关（77对120分钟；p<0.001）、更短的住院时间（0对1天；p=0.003）以及更高的当日出院率（60.5%对23.7%；OR 4.94，95% CI 1.83-13.31；p=0.002）。经协变量调整后，机器人手术时间估计仍短11%，但置信区间包含无差异（时间比0.89，95% CI 0.72-1.09；p=0.250）。当日出院的关联在调整后仍然存在（OR 5.02，95% CI 1.09-23.00；p=0.038）。
结论： 机器人抗反流与食管裂孔手术已成功整合到一家成熟的良性UGI服务中，包括承担相当数量的修正手术工作量。有利的手术时间和当日出院率显示了高效服务提供的潜力，尽管平台、外科医生专长、病例选择和治疗时代的各自贡献无法区分。这些发现证明了可行性，并支持对其比较临床和经济价值进行进一步前瞻性评估。
英文摘要
Robotic fundoplication is rapidly expanding across the UK, however, robust comparative data from routine benign upper gastrointestinal (UGI) practice remain limited. This study compares perioperative outcomes of robotic and laparoscopic fundoplication within a UK benign UGI unit. This retrospective observational study included consecutive adults undergoing elective laparoscopic or robotic anti-reflux or hiatal surgery between February 2022 and January 2026. The primary outcome was total operative time. Secondary outcomes included length of stay, same-day discharge, complications, 30-day readmission, 30-day return to theatre, subsequent redofundoplication and early clinically recorded recurrence. One hundred patients were included: 57 robotic and 43 laparoscopic. Revisional surgery was more frequent robotically (33.3% versus 11.6%; p = 0.006). Overall, robotic procedures had shorter median operative times (88 versus 120 min; p = 0.017) and higher same-day discharge rates (63.2% versus 27.9%). After excluding the highest-volume robotic surgeon, median robotic operative time remained 27 min shorter than laparoscopy (93 versus 120 min), although the difference was no longer statistically significant (p = 0.16). Among 76 primary operations, robotics was associated with shorter unadjusted operative time (77 versus 120 min; p < 0.001), shorter length of stay (0 versus 1 day; p = 0.003) and higher same-day discharge (60.5% versus 23.7%; OR 4.94, 95% CI 1.83-13.31; p = 0.002). Following covariate adjustment, operative time remained an estimated 11% shorter robotically, although the confidence interval included no difference (time ratio 0.89, 95% CI 0.72-1.09; p = 0.250). The association with same-day discharge persisted after adjustment (OR 5.02, 95% CI 1.09-23.00; p = 0.038). Robotic anti-reflux and hiatal surgery was successfully integrated into an established benign UGI service, including for a substantial revisional workload. Favourable operative times and same-day discharge rates demonstrate the potential for efficient service delivery, although the respective contributions of platform, surgeon expertise, case selection and treatment era cannot be separated. These findings demonstrate feasibility and support further prospective evaluation of its comparative clinical and economic value.