Objective: To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications. Methods: A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis. Results: (1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ(2)=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ(2)=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ(2)=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ(2)=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ(2)=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ(2)=5.684, P=0.015) and Ⅲ (χ(2)=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ(2)=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ(2)=15.801, P=0.000), preoperative anemia (χ(2)=14.299, P=0.000), total number of lymph node resection (χ(2)=10.425, P=0.001), surgical methods (χ(2)=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions: Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.
目的： 探讨机器人系统辅助腹腔镜手术及传统腹腔镜手术治疗Ⅰ期（包括Ⅰa期和Ⅰb期）子宫内膜癌患者手术并发症的发生情况，并分析影响手术并发症发生的相关危险因素。 方法： 采用回顾性病例对照研究的方法，对2014年10月—2019年6月在郑州大学第一附属医院接受腹腔镜手术治疗的421例Ⅰ期子宫内膜癌患者的临床病理资料进行分析，根据手术方式不同分为机器人组（采用机器人系统辅助腹腔镜手术，131例）和传统腹腔镜组（采用传统腹腔镜手术，290例），采用Clavein-Dindo分级标准对手术并发症的严重程度进行分级，比较两组患者手术并发症的发生率及严重程度的差异；并对影响Ⅰ期子宫内膜癌患者手术并发症发生的相关因素，如年龄、体质指数（BMI）、有无合并症、既往盆腔手术史、美国麻醉医师协会（ASA）分级（对身体状况进行分级）、术前贫血、盆腔淋巴结切除数、腹主动脉旁淋巴结切除数、总淋巴结切除数、手术时间、手术方式（指机器人系统辅助腹腔镜手术与传统腹腔镜手术），进行单因素（采用χ(2)检验）和多因素（采用logistic回归法）分析。 结果： （1）手术并发症的发生率：机器人组总手术并发症的发生率明显低于传统腹腔镜组[分别为20.6%（27/131）、34.8%（101/290）；χ(2)=8.620，P=0.003]。机器人组与传统腹腔镜组比较，术中并发症的发生率[分别为1.5%（2/131）、6.2%（18/290）；χ(2)=4.368，P=0.037]显著降低，其中机器人组术中血管损伤的发生率明显低于传统腹腔镜组[分别为0.8%（1/131）、5.2%（15/290）；χ(2)=4.798，P=0.022]；术后并发症的发生率[分别为19.1%（25/131）、28.6%（83/290）；χ(2)=4.303，P=0.038]也显著降低，但机器人组术后淋巴漏的发生率高于传统腹腔镜组[分别为10.7%（14/131）、5.2%（15/290）；χ(2)=4.279，P=0.039]。（2）手术并发症的严重程度：机器人组与传统腹腔镜组患者的Clavein-Dindo Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级手术并发症的发生率分别为3.8%（5/131）和11.0%（32/290）、13.7%（18/131）和14.5%（42/290）、3.1%（4/131）和8.6%（25/290）、0（0/131）和0.3%（1/290）、0（0/131）和0.3%（1/290），两组间Ⅰ级（χ(2)=5.684，P=0.015）、Ⅲ级（χ(2)=4.361，P=0.037）手术并发症的发生率分别比较，差异均有统计学意义。机器人组患者严重并发症的发生率显著低于传统腹腔镜组[分别为3.1%（4/131）和9.3%（27/290）；χ(2)=5.179，P=0.023]。（3）影响手术并发症发生的相关危险因素：单因素分析显示，BMI（χ(2)=15.801，P=0.000）、术前贫血（χ(2)=14.299，P=0.000）、总淋巴结切除数（χ(2)=10.425，P=0.001）、手术方式（χ(2)=8.620，P=0.003）是影响Ⅰ期子宫内膜癌患者手术并发症发生的危险因素。多因素分析显示，BMI（OR=0.289，95%CI为0.097~0.864，P=0.026）、术前贫血（OR=0.309，95%CI为0.129~0.740，P=0.008）、总淋巴结切除数（OR=0.624，95%CI为0.403~0.966，P=0.034）、手术方式（OR=3.491，95%CI为1.030~11.840，P=0.045）是影响Ⅰ期子宫内膜癌患者手术并发症发生的独立危险因素。 结论： 机器人系统辅助腹腔镜手术较传统腹腔镜手术治疗Ⅰ期子宫内膜癌的并发症少，且严重并发症的发生率低。BMI、术前贫血、总淋巴结切除数、手术方式是影响Ⅰ期子宫内膜癌患者手术并发症发生的独立危险因素。.
Keywords: Endometrial neoplasms; Intraoperative complications; Laparoscopy; Postoperative complications; Risk factors; Robotics.