Application Effect of Robot-Assisted Laparoscopy in Hepatectomy for Colorectal Cancer Patients with Liver Metastases

摘要

Objective. Application effect of Leonardo’s robot-assisted laparoscopy in hepatectomy for colorectal cancer patients with liver metastases. Methods. A total of 122 patients with sCRLM treated in our hospital from May 2015 to June 2018 were selected and divided into observation group ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>n</a:mi> <a:mo>=</a:mo> <a:mn>61</a:mn> </a:math> ) and control group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>n</c:mi> <c:mo>=</c:mo> <c:mn>61</c:mn> </c:math> ) according to random number table method. The observation group was treated with robot-assisted laparoscopic hepatectomy, while the control group was treated with conventional laparoscopic hepatectomy. The perioperative time, intraoperative blood transfusion, intraoperative blood loss, average intraoperative blood transfusion, and hepatic portal occlusion time of the two groups were observed. Serum cortisol (Cor), norepinephrine (NE), and glucose (Glu) levels were detected before and after surgery in the two groups. The oxygen consumption and carbon dioxide output of patients were measured 1 day before surgery and 1~3 days after surgery, and the resting energy expenditure (REE) value was calculated. The levels of CD3+, CD4+, and CD8+ were determined by flow cytometry. The incidence of complications was compared between the two groups. Patients were followed up for 3 years after discharge, and Kaplan-Meier method was used to analyze the survival of the two groups. Results. The operation time, intraoperative blood transfusion, intraoperative blood loss, and average intraoperative blood transfusion in the observation group were all less than those in the control group, and the differences were statistically significant ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>&lt;</e:mo> <e:mn>0.05</e:mn> </e:math> ). Three days after operation, the levels of serum Cor, NE, and Glu were increased in both groups, and the observation group was lower than the control group; the difference was statistically significant ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>&lt;</g:mo> <g:mn>0.05</g:mn> </g:math> ). The REE level of observation group was lower than that of control group after 1 day, 2 days, and 3 days after surgery, and the difference was statistically significant ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>&lt;</i:mo> <i:mn>0.05</i:mn> </i:math> ). Three days after operation, the levels of serum CD3+ and CD4+ were decreased in both groups, and the observation group was higher than the control group; the difference was statistically significant ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>&lt;</k:mo> <k:mn>0.05</k:mn> </k:math> ). The incidence of complications in the observation group (3.28%) was lower than that in the control group (13.11%); the difference was statistically significant ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo>&lt;</m:mo> <m:mn>0.05</m:mn> </m:math> ).There was no significant difference in survival rate between the two groups after 1, 2, and 3 years of follow-up ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>P</o:mi> <o:mo>&gt;</o:mo> <o:mn>0.05</o:mn> </o:math> ). Conclusion. The application of robot-assisted laparoscopy in patients with sCRLM can effectively improve the perioperative situation of patients, reduce stress, energy metabolism, and immune damage, and reduce the incidence of complications.