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2026年8月20日星期四
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机器人辅助微创食管切除术（RAMIE）中的术中不良事件：发生率、处理及对手术结局的影响

Intraoperative Adverse Events in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Incidence, Management, and Impact on Surgical Outcomes.

期刊
Annals of Surgery
PMID
42613668
原文
PubMed ↗
发布日期

作者

  • Franco Badaloni — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Adam Zeyara — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Gino M Kuiper — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Stijn Vanstraelen — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Ludovico Campi — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Jan Willem van den Berg — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Richard van Hillegersberg — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Jelle P Ruurda — Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

作者单位

  • Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

摘要

中文

评估机器人辅助微创食管切除术（RAMIE）中术中不良事件（IAEs）的发生率和处理，并评估其对术后结局的影响。IAEs是外科实践的固有组成部分，由于食管切除术的复杂性，也不例外。关于其发生率和处理的数据仍然有限。机器人辅助可能有助于处理这些事件。本回顾性观察队列研究分析了UMC Utrecht使用da Vinci Xi系统连续进行的RAMIE的前瞻性收集数据。使用ClassIntra分类对iAEs进行分级。根据主要IAEs（ClassIntra≥III）的发生比较围手术期结局。2018年至2025年间，共进行了478例RAMIE。41例患者（8.6%；46个事件）发生IAEs，其中92.7%通过机器人处理而无需中转开胸。出血是最常见的事件（69.6%），其次是乳糜漏（8.7%）、肺损伤（8.7%）和气道损伤（4.3%）。主要IAEs发生在20例患者（4.2%）中，与平均失血量增加（1211 vs 296 mL，P<0.001）、更高的中转率（15.0% vs 1.3%，P=0.005）和更长的手术时间（478.6 vs 413.3分钟，P=0.022）相关。主要术后并发症（35.0% vs 37.3%，P=1.000）、中位住院时间（11 vs 11天，P=0.311）和院内死亡率（5.0% vs 2.7%，P=0.446）在组间相当。在本回顾性队列中，超过90%的RAMIE期间IAEs通过机器人处理无需中转，术后并发症没有显著增加。这些结果应在专家中心和事件数有限的背景下进行解读。

English

Assess the incidence and management of intraoperative adverse events (IAEs) during robot-assisted minimally invasive esophagectomy (RAMIE) and evaluate their impact on postoperative outcomes. IAEs are an inherent component of surgical practice and owing to its complexity, esophagectomy is no exception. Data on their incidence and management remain limited. Robotic assistance may facilitate management of these events. This retrospective observational cohort study analyzed prospectively collected data from consecutive RAMIE performed at UMC Utrecht using the da Vinci Xi system. iAEs were categorized using the ClassIntra classification. Perioperative outcomes were compared according to major IAEs occurrence (ClassIntra ≥III). Between 2018 and 2025, 478 RAMIE were performed. IAEs occurred in 41 patients (8.6%; 46 events), of which 92.7% were managed robotically without conversion. Bleeding was the most common event (69.6%), followed by chyle leaks (8.7%), lung injuries (8.7%), and airway injuries (4.3%). Major IAEs occurred in 20 patients (4.2%) and were associated with increased mean blood loss (1211 vs. 296 mL, P<0.001), higher conversion rates (15.0% vs. 1.3%, P=0.005) and longer mean operative time (478.6 vs. 413.3 min, P=0.022). Major postoperative complications (35.0% vs. 37.3%, P=1.000), median hospital length of stay (11 vs. 11 d, P=0.311) and in-hospital mortality (5.0% vs. 2.7%, P=0.446) were comparable between groups. In this retrospective cohort, over 90% of IAEs during RAMIE were managed robotically without conversion, with no significant increase in postoperative morbidity. These results should be interpreted in the context of an expert center and a limited number of events.

分类与指标

研究类型
临床研究
病种
食管癌
JCR 分区
Q1
影响因子
7.4
新锐分区
1区