PDF(Pubmed)
Abstract：
Vaginectomy has been shown to be effective for select patients with vaginal high-grade squamous intraepithelial lesions (HSIL) and is favored by gynecologists, while there are few reports on the robotic-assisted laparoscopic vaginectomy (RALV). The aim of this study was to evaluate the safety and treatment outcomes between RALV and the conventional laparoscopic vaginectomy (CLV) for patients with vaginal HSIL.
This retrospective cohort study was conducted in 109 patients with vaginal HSIL who underwent either RALV (RALV group) or CLV (CLV group) from December 2013 to May 2022. The operative data, homogeneous HPV infection regression rate and vaginal HSIL regression rate were compared between the two groups. Student\'s t-test, the Mann-Whitney U test, Pearson χ2 test or the Fisher exact test, Kaplan-Meier survival analysis and Cox proportional-hazards models were used for data analysis.
There were 32 patients in the RALV group and 77 patients in the CLV group. Compared with the CLV group, patients in the RALV group demonstrated less estimated blood loss (41.6 ± 40.3 mL vs. 68.1 ± 56.4 mL, P = 0.017), lower intraoperative complications rate (6.3% vs. 24.7%, P = 0.026), and shorter flatus passing time (2.0 (1.0-2.0) vs. 2.0 (2.0-2.0), P < 0.001), postoperative catheterization time (2.0 (2.0-3.0) vs. 4.0 (2.0-6.0), P = 0.001) and postoperative hospitalization time (4.0 (4.0-5.0) vs. 5.0 (4.0-6.0), P = 0.020). In addition, the treatment outcomes showed that both RALV group and CLV group had high homogeneous HPV infection regression rate (90.0% vs. 92.0%, P > 0.999) and vaginal HSIL regression rate (96.7% vs. 94.7%, P = 0.805) after vaginectomy. However, the RALV group had significantly higher hospital costs than that in the CLV group (53035.1 ± 9539.0 yuan vs. 32706.8 ± 6659.2 yuan, P < 0.001).
Both RALV and CLV can achieve satisfactory treatment outcomes, while RALV has the advantages of less intraoperative blood loss, fewer intraoperative complications rate and faster postoperative recovery. Robotic-assisted surgery has the potential to become a better choice for vaginectomy in patients with vaginal HSIL without regard to the burden of hospital costs.
This retrospective cohort study was conducted in 109 patients with vaginal HSIL who underwent either RALV (RALV group) or CLV (CLV group) from December 2013 to May 2022. The operative data, homogeneous HPV infection regression rate and vaginal HSIL regression rate were compared between the two groups. Student\'s t-test, the Mann-Whitney U test, Pearson χ2 test or the Fisher exact test, Kaplan-Meier survival analysis and Cox proportional-hazards models were used for data analysis.
There were 32 patients in the RALV group and 77 patients in the CLV group. Compared with the CLV group, patients in the RALV group demonstrated less estimated blood loss (41.6 ± 40.3 mL vs. 68.1 ± 56.4 mL, P = 0.017), lower intraoperative complications rate (6.3% vs. 24.7%, P = 0.026), and shorter flatus passing time (2.0 (1.0-2.0) vs. 2.0 (2.0-2.0), P < 0.001), postoperative catheterization time (2.0 (2.0-3.0) vs. 4.0 (2.0-6.0), P = 0.001) and postoperative hospitalization time (4.0 (4.0-5.0) vs. 5.0 (4.0-6.0), P = 0.020). In addition, the treatment outcomes showed that both RALV group and CLV group had high homogeneous HPV infection regression rate (90.0% vs. 92.0%, P > 0.999) and vaginal HSIL regression rate (96.7% vs. 94.7%, P = 0.805) after vaginectomy. However, the RALV group had significantly higher hospital costs than that in the CLV group (53035.1 ± 9539.0 yuan vs. 32706.8 ± 6659.2 yuan, P < 0.001).
Both RALV and CLV can achieve satisfactory treatment outcomes, while RALV has the advantages of less intraoperative blood loss, fewer intraoperative complications rate and faster postoperative recovery. Robotic-assisted surgery has the potential to become a better choice for vaginectomy in patients with vaginal HSIL without regard to the burden of hospital costs.
摘要：
背景：阴道切除术已被证明对阴道高度鳞状上皮内病变（HSIL）的特定患者有效，并受到妇科医生的青睐，而机器人辅助腹腔镜阴道切除术（RALV）的报道很少。这项研究的目的是评估RALV和常规腹腔镜阴道切除术（CLV）对阴道HSIL患者的安全性和治疗效果。
方法：这项回顾性队列研究是在2013年12月至2022年5月期间接受RALV（RALV组）或CLV（CLV组）的109例阴道HSIL患者中进行的。操作数据,比较两组均一HPV感染消退率和阴道HSIL消退率。学生t检验，Mann-WhitneyU测试,Pearsonχ2检验或Fisher精确检验，使用Kaplan-Meier生存分析和Cox比例风险模型进行数据分析。
结果：RALV组32例，CLV组77例。与CLV组相比，RALV组患者的估计失血量较少（41.6±40.3mLvs.68.1±56.4mL,P=0.017),术中并发症发生率较低（6.3%vs.24.7%,P=0.026),和更短的肛门通过时间（2.0（1.0-2.0）与2.0（2.0-2.0），P<0.001)，术后导尿时间（2.0（2.0-3.0）vs.4.0（2.0-6.0），P=0.001）和术后住院时间（4.0（4.0-5.0）vs.5.0(4.0-6.0),P=0.020)。此外,治疗结果显示，RALV组和CLV组均有较高的均一HPV感染消退率（90.0%vs.92.0%,P>0.999）和阴道HSIL消退率（96.7%vs.94.7%,阴道切除术后P=0.805）。然而,RALV组的住院费用明显高于CLV组（53035.1±9539.0元vs。32706.8±6659.2元,P<0.001)。
结论：RALV和CLV均可获得满意的治疗结果，而RALV具有术中出血量少的优点，术中并发症发生率低,术后恢复快。机器人辅助手术有可能成为阴道HSIL患者阴道切除术的更好选择，而不考虑医院费用的负担。
方法：这项回顾性队列研究是在2013年12月至2022年5月期间接受RALV（RALV组）或CLV（CLV组）的109例阴道HSIL患者中进行的。操作数据,比较两组均一HPV感染消退率和阴道HSIL消退率。学生t检验，Mann-WhitneyU测试,Pearsonχ2检验或Fisher精确检验，使用Kaplan-Meier生存分析和Cox比例风险模型进行数据分析。
结果：RALV组32例，CLV组77例。与CLV组相比，RALV组患者的估计失血量较少（41.6±40.3mLvs.68.1±56.4mL,P=0.017),术中并发症发生率较低（6.3%vs.24.7%,P=0.026),和更短的肛门通过时间（2.0（1.0-2.0）与2.0（2.0-2.0），P<0.001)，术后导尿时间（2.0（2.0-3.0）vs.4.0（2.0-6.0），P=0.001）和术后住院时间（4.0（4.0-5.0）vs.5.0(4.0-6.0),P=0.020)。此外,治疗结果显示，RALV组和CLV组均有较高的均一HPV感染消退率（90.0%vs.92.0%,P>0.999）和阴道HSIL消退率（96.7%vs.94.7%,阴道切除术后P=0.805）。然而,RALV组的住院费用明显高于CLV组（53035.1±9539.0元vs。32706.8±6659.2元,P<0.001)。
结论：RALV和CLV均可获得满意的治疗结果，而RALV具有术中出血量少的优点，术中并发症发生率低,术后恢复快。机器人辅助手术有可能成为阴道HSIL患者阴道切除术的更好选择，而不考虑医院费用的负担。
