直腸癌患者接受機器手臂手術及腹腔鏡手術的比較

論文名稱：直腸癌患者接受機器手臂手術及腹腔鏡手術的比較研究所名稱：臺北醫學大學醫務管理學系碩士在職專班研究生姓名：陳雅雲畢業時間：102學年度第2學期指導教授：李顯章臺北醫學大學醫務管理學系副教授前言在大腸直腸癌 ( Colorectal Cancer, CRC ) 患者之中，有40% 的腫瘤是生長在直腸，而直腸癌的局部復發率高，手術治療亦較大腸癌困難，但隨著時代朝流及科技的精進，現今直腸癌的手術治療已有長足的進步。近年來腹腔鏡微創手術蓬勃發展，國內外已有許多大型的臨床試驗及研究證據顯示，大腸癌腫瘤切除手術以腹腔鏡微創手術進行，在術後恢復及腫瘤廓清的手術結果面，都已證實會得到比傳統剖腹手術好的結果及數據，但這些臨床證據並未包含直腸癌患者。對此，國際上已有各國專家們進行更深入的直腸癌腹腔鏡手術與傳統剖腹手術的臨床試驗 ( COLOR II and COREAN trials )，研究結果證明腹腔鏡直腸癌手術比傳統剖腹手術可以達到更完善的目標，在術後恢復會比傳統剖腹手術好。更甚者，目前還有新穎的治療武器：機器手臂手術系統，但運用於直腸癌的手術上，國外目前只有短期研究的結果發表；而國內雖然直腸癌患者眾多，近年來亦已開始運用機器手臂手術系統進行治療，但目前並無與腹腔鏡比較的相關性研究。因此，期望藉此研究，探討直腸癌患者接受腹腔鏡手術與機器手臂微創手術後的手術結果比較，能得到本土性之研究結果，提供臨床醫護人員及患者在治療選擇上之參考。研究方法本研究採立意取樣法、非雙盲、平行式研究。回溯性收集自2012年01月01日到2014年04月30日之中、低位直腸癌個案共50位，全部個案皆先接受過手術前同步放射、化學治療，在此前導性治療完成後，由醫師會為患者解說機器手臂手術系統及腹腔鏡手術的異同及優缺點，然後依病人意願選擇手術方式，再依其選擇之手術方式分為機器手臂手術一組、腹腔鏡手術一組。所有患者皆由同一手術醫師執行手術。研究結果兩組患者各有25位個案，在男女性別、年齡、身體質量指數 ( Body Mass Index, BMI )等基本屬性的條件比率相同。研究結果顯示，腫瘤的遠端切緣距離 ( Distal resection margin )及近端切緣距離 ( Proximal resection margin ) 的長度，和腫瘤環週切緣 ( Circumferential resection margin, CRM ) 是否被侵犯，還有淋巴結清除數目之比較皆無顯著差異。唯兩組患者在手術時間上是具有統計上的意義，機器手臂手術組比腹腔鏡手術組的手術時間長。結論本研究案的研究結果顯示，機器手臂手術組比腹腔鏡手術組的手術時間長，除此之外，機器手臂手術與腹腔鏡手術一樣，可以為直腸癌患者提供同樣安全的腫瘤切除手術，無論是手術後的恢復或腫瘤廓清結果的比較，兩組的結果都無明顯差異。關鍵字：大腸直腸癌、直腸癌、直腸癌機器手臂手術、大腸癌腹腔鏡手術、直腸癌腹腔鏡手術、機器手臂手術與腹腔鏡手術

關鍵字

大腸直腸癌；直腸癌；直腸癌機器手臂手術；大腸癌腹腔鏡手術；直腸癌腹腔鏡手術；機器手臂手術與腹腔鏡手術

並列摘要

Title of Thesis: Robotic versus Laparoscopic Surgeryfor Rectal Cancer Author: Ya-Yun Chen Thesis advised by: Hsien-Chang Li, Ph.D., Professor. Introduction: Several multi-institutional prospective randomized trials demonstrated that laparoscopic colectomy for colon cancer provided better recovery with comparable oncologic results to open surgery. However, rectal cancer was excluded in previously reported trials. Recently, COLOR II and COREAN trials demonstrated that laparoscopic rectal cancer surgery could be safely performed and it provided better post-operative recovery without compromise of short term oncological results. Laparoscopic surgery for rectal cancer is a technically demanding procedure. Robotic surgery may be a solution for this problem. Only few comparative studies between laparoscopic and robotic rectal cancer surgery were published recently. Robotic rectal surgery was introduced into Taiwan in 2004 but there is still no comparative study between laparoscopic and robotic rectal surgery for rectal cancer. In this study, short term results between these two methods were compared. Materials and Methods: This is a case matched study with patients operated from Jan. 2012 to Apr. 2014. Potential benefits and drawbacks about robotic and laparoscopic surgery were well explained to patients and their family. Robotic surgery was offered to patients with middle or lower rectal cancer and laparoscopic resection was performed when the patient refused robotic surgery. All patients received pre-operative radiotherapy and all operations were performed by single surgical team. Results: There were 50 patients with middle or lower rectal cancer and 25 patients received robotic surgery. Gender, age and BMI were matched for both robotic and laparoscopic group. Distance of tumor low margin from anal verge、circumferential resection margin and number of lymph nodes harvested were not significantly different. Operation time is significantly longer in robotic group. However, intra-operative bleeding, post-operative recovery and oncologic results were not significantly different between two methods. Conclusion: Although operation time was longer, robotic rectal cancer surgery provided same post-operative recovery and short term oncologic results as laparoscopic surgery did even in early experience period. Key words：Colonrectal cancer, Rectal cancer, Robotic rectal cancer surgery, Laparoscopic colectomy for colon cancer, Laparoscopic rectal cancer surgery, Robotic and laparoscopic surgery

並列關鍵字

Colonrectal cancer ； Rectal cancer ； Robotic rectal cancer surgery ； Laparoscopic colectomy for colon cancer ； Laparoscopic rectal cancer surgery ； Robotic and laparoscopic surgery

參考文獻

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直腸癌患者接受機器手臂手術及腹腔鏡手術的比較

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