机器人辅助对比腹腔镜下复杂腹壁疝手术短期疗效分析

doi:10.3877/cma.j.issn.1674-392X.2026.01.013

中华疝和腹壁外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 68 -73. doi: 10.3877/cma.j.issn.1674-392X.2026.01.013

论著

机器人辅助对比腹腔镜下复杂腹壁疝手术短期疗效分析

王宏¹^,²^,³, 董国强¹^,²^,³, 张兴洲¹^,²^,³, 刘韦鋆¹^,²^,³, 张楠¹^,²^,³^,^†(

)

¹300100　天津市南开医院胃肠外科二
²300100　天津市中西医结合急腹症研究所
³300100　天津市急腹症器官损伤与中西医修复重点实验室

收稿日期:2025-08-29 出版日期:2026-02-18
通信作者: 张楠
基金资助:
天津市卫生健康委员会中医中西医结合科研课题(2023096、2023167); 河北省中医药管理局科研课题(T2025040); 天津市教委科研计划项目(2024KJ246)

Short-term efficacy comparison between robot-assisted and laparoscopic surgery for complex abdominal wall hernias

Hong Wang¹^,²^,³, Guoqiang Dong¹^,²^,³, Xingzhou Zhang¹^,²^,³, Weijun Liu¹^,²^,³, Nan Zhang¹^,²^,³^,^†()

¹Second Department of Gastrointestinal Surgery, Tianjin NanKai Hospital, Tianjin 300100, China
²Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin 300100, China
³Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin 300100, China

Received:2025-08-29 Published:2026-02-18
Corresponding author: Nan Zhang

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引用本文：

王宏, 董国强, 张兴洲, 刘韦鋆, 张楠. 机器人辅助对比腹腔镜下复杂腹壁疝手术短期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 68-73.

Hong Wang, Guoqiang Dong, Xingzhou Zhang, Weijun Liu, Nan Zhang. Short-term efficacy comparison between robot-assisted and laparoscopic surgery for complex abdominal wall hernias[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(01): 68-73.

目的

探讨机器人辅助下治疗复杂腹壁疝的安全性与短期疗效。

方法

本研究为回顾性队列研究。回顾性分析2023年2月至2025年2月在天津市南开医院行复杂腹壁疝修补手术的41例患者的临床资料。依据手术方式的不同，将患者分为LH组（行腹腔镜腹壁疝无张力修补术, n=23）及RH组（行机器人辅助腹壁疝无张力修补术，n=18）。比较2组患者围手术期情况（腹腔粘连评分、术中出血量、手术时间、腹壁缺损直径），术后第3天、1周、1个月、3个月的疼痛视觉模拟评分法（VAS）得分，疝复发、肠梗阻、肠瘘、伤口感染、补片感染、血肿及血清肿等术后并发症发生情况。依据疝类别的不同，两组分别分为A组[巨大腹壁疝（最大缺损>10 cm）]、B组（合并严重腹腔粘连腹壁疝）、C组（复发/多发疝）、D组（边缘区疝）、E组（嵌顿/绞窄疝）5个亚组，并对病例数≥6的亚组进一步行统计学分析。

结果

2组患者的一般资料比较，差异无统计学意义（P>0.05）。2组患者的围手术期情况（腹腔粘连评分、术中出血量、手术时间、腹壁缺损直径）比较，差异均无统计学意义（P>0.05）；RH组患者术后1周、1个月的疼痛VAS评分，及亚组D组术后各观察时点的疼痛VAS评分均较LH组的更低，差异均有统计学意义（P<0.05）。LH组随访6~24个月，RH组随访3~12个月，所有患者均获随访。随访期间，LH组出现血清肿2例、术后1年疝复发1例、慢性疼痛1例，RH组出现血清肿1例，总并发症发生率分别为17.4%（4/23）、6%（1/18），组间差异无统计学意义（P=0.258）。

结论

机器人辅助与腹腔镜下手术治疗复杂腹壁疝的安全性相当，但机器人辅助技术在复杂腹壁疝修补方面较传统腔镜手术具有操作精准、术后疼痛轻等优势，尤其对边缘区切口疝疼痛控制优势显著。

关键词: 复杂腹壁疝, 疝修补术, 机器人辅助手术治疗, 达芬奇机器人操作系统, 回顾性分析

Objective

To evaluate the safety and short-term efficacy of robot-assisted surgery in the treatment of complex abdominal wall hernia.

Methods

This was a retrospective cohort study. A retrospective analysis was performed on the clinical data of 41 patients who underwent complex abdominal wall hernia repair at Tianjin Nankai Hospital between February 2023 and February 2025. According to different surgical approaches, patients were divided into the LH group (laparoscopic tension-free abdominal wall hernia repair, n=23) and the RH group (robot-assisted tension-free abdominal wall hernia repair, n=18). The perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, and diameter of abdominal wall defect), Visual Analogue Scale (VAS) pain scores at postoperative 3 days, 1 week, 1 month, and 3 months, as well as the incidence rate of postoperative complications including hernia recurrence, intestinal obstruction, intestinal fistula, wound infection, mesh infection, hematoma, and seroma were compared between the two groups. According to different hernia types, patients were divided into 5 subgroups: group A [giant abdominal wall hernia (maximum defect>10 cm)], group B (abdominal wall hernia with severe intra-abdominal adhesions), group C (recurrent/multiple hernias), group D (marginal hernia), and group E (incarcerated/strangulated hernia). Statistical analysis was further performed for subgroups with a case number of≥6.

Results

There was no statistically significant difference in general data between the two groups (P>0.05). No significant differences were found in the perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, abdominal wall defect diameter) between the two groups (P>0.05). The VAS pain scores at 1 week and 1 month postoperatively in the RH group, as well as at all observed time points in subgroup D, were lower than those in the LH group, with statistically significant differences (P<0.05). The LH group was followed up for 6-24 months, and the RH group for 3-12 months. All patients completed the follow-up. During the follow-up period, the LH group had 2 cases of seroma, 1 case of hernia recurrence at 1 year postoperatively, and 1 case of chronic pain. The RH group had 1 case of seroma.The total complication rates were 17.4% (4/23) and 6% (1/18), respectively, with no statistically significant difference between the two groups (P=0.258).

Conclusion

Robotic- assisted and laparoscopic surgery have comparable safety in the treatment of complex abdominal wall hernia. Compared with conventional laparoscopic surgery, robotic-assisted technology offers advantages such as improved surgical precision and less postoperative pain in complex abdominal wall hernia repair, especially in pain control for marginal incisional hernias.

Key words: Complex abdominal wall hernia, Herniorrhaphy, Robot-assisted surgical treatment, Da Vinci robot operating system, Retrospective analysis

图5 缝合固定补片完成

表1 2组复杂腹壁疝患者的基线资料比较

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	疝类别^a[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	A	B	C	D	E
LH组	23	7(30.4)	16(69.6)	60.43±8.27	26.41±3.49	6(26.1)	3(13.0)	6(26.1)	10(43.5)	1(4.3)
RH组	18	9(50.0)	9(50.0)	58.83±14.35	26.80±3.44	7(38.9)	1(5.6)	7(38.9)	7(38.9)	0(0.0)
χ²/t值		1.54		0.42	-0.36	-
P值		0.215		0.678	0.721	0.583

表1 2组复杂腹壁疝患者的基线资料比较

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	疝类别^a[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	A	B	C	D	E
LH组	23	7(30.4)	16(69.6)	60.43±8.27	26.41±3.49	6(26.1)	3(13.0)	6(26.1)	10(43.5)	1(4.3)
RH组	18	9(50.0)	9(50.0)	58.83±14.35	26.80±3.44	7(38.9)	1(5.6)	7(38.9)	7(38.9)	0(0.0)
χ²/t值		1.54		0.42	-0.36	-
P值		0.215		0.678	0.721	0.583

表2 2组复杂腹壁疝患者手术相关指标的比较[M(Q₁，Q₃)]

组别	例数	腹腔粘连评分(分)	术中出血量(ml)	手术时间(min)	腹壁缺损直径(cm)
LH组	23	5.00(3.00,7.00)	49.13(25.00,73.26)	149.35(100.00,198.70)	7.70(4.90,10.50)
A	6	5.33(3.00,7.67)	38.33(25.00,51.67)	137.50(100.00,175.00)	15.00(12.00,18.00)
B	3	8.00(7.00,9.00)	106.67(95.00,118.33)	276.00(256.00,296.00)	5.67(3.00,8.33)
C	6	4.83(2.19,7.47)	46.67(20.00,73.33)	154.17(90.00,218.34)	7.67(4.46,10.88)
D	10	4.90(3.00,6.80)	48.00(25.00,71.00)	138.00(80.00,196.00)	4.90(2.60,7.20)
E	1	3.00	20.00	120.00	4.00
RH组	18	5.56(4.00,7.12)	32.80(15.00,50.60)	166.67(125.00,208.34)	9.17(7.29,11.05)
A	7	7.29(6.00,8.57)	47.10(30.00,64.30)	193.57(140.00,247.14)	13.00(11.00,15.00)
B	1	9.00	60.00	200.00	10.00
C	7	5.50(4.50,6.50)	28.30(15.00,41.70)	178.57(138.00,219.14)	8.13(5.00,11.26)
D	7	3.71(2.50,5.00)	20.71(10.00,31.43)	125.00(106.00,144.00)	7.29(5.00,9.58)
Z值^a		-0.78	-1.21	-0.65	-1.32
P值		0.435	0.226	0.516	0.187

表2 2组复杂腹壁疝患者手术相关指标的比较[M(Q₁，Q₃)]

组别	例数	腹腔粘连评分(分)	术中出血量(ml)	手术时间(min)	腹壁缺损直径(cm)
LH组	23	5.00(3.00,7.00)	49.13(25.00,73.26)	149.35(100.00,198.70)	7.70(4.90,10.50)
A	6	5.33(3.00,7.67)	38.33(25.00,51.67)	137.50(100.00,175.00)	15.00(12.00,18.00)
B	3	8.00(7.00,9.00)	106.67(95.00,118.33)	276.00(256.00,296.00)	5.67(3.00,8.33)
C	6	4.83(2.19,7.47)	46.67(20.00,73.33)	154.17(90.00,218.34)	7.67(4.46,10.88)
D	10	4.90(3.00,6.80)	48.00(25.00,71.00)	138.00(80.00,196.00)	4.90(2.60,7.20)
E	1	3.00	20.00	120.00	4.00
RH组	18	5.56(4.00,7.12)	32.80(15.00,50.60)	166.67(125.00,208.34)	9.17(7.29,11.05)
A	7	7.29(6.00,8.57)	47.10(30.00,64.30)	193.57(140.00,247.14)	13.00(11.00,15.00)
B	1	9.00	60.00	200.00	10.00
C	7	5.50(4.50,6.50)	28.30(15.00,41.70)	178.57(138.00,219.14)	8.13(5.00,11.26)
D	7	3.71(2.50,5.00)	20.71(10.00,31.43)	125.00(106.00,144.00)	7.29(5.00,9.58)
Z值^a		-0.78	-1.21	-0.65	-1.32
P值		0.435	0.226	0.516	0.187

表3 2组复杂腹壁疝患者术后不同时间VAS评分比较

组别	例数	术后第3天	术后1周	术后1个月	术后3个月
LH组	23	4.39(3.66,5.13)	2.87(2.23,3.51)	1.39(1.01,1.77)	0.57(0.09,1.05)
A	6	4.33(3.00,5.67)	2.67(1.76,3.67)	1.33(0.86,1.80)	0.50(0.00,1.00)
B	3	3.33(2.76,3.90)	2.33(1.39,3.27)	1.33(0.75,1.91)	0.33(0.00,0.76)
C	6	3.83(3.14,4.52)	2.50(1.54,3.46)	1.17(0.80,1.54)	0.33(0.00,0.76)
D	10	5.30(4.70,5.90)	3.50(3.00,4.00)	1.60(0.89,2.31)	0.80(0.00,1.60)
E	1	5.00	3.00	1.00	1.00
RH组	18	3.83(3.18,4.48)	2.11(1.67,2.56)	0.83(0.33,1.33)	0.39(0.00,0.78)
A	7	4.14(3.00,3.86)	2.14(1.57,2.71)	0.86(0.51,1.21)	0.43(0.00,0.86)
B	1	3.00	2.00	0.00	0.00
C	7	3.43(3.00,3.86)	2.00(1.47,2.53)	0.71(0.26,1.16)	0.29(0.00,0.72)
D	7	3.71(3.00,4.42)	2.29(1.54,3.04)	1.14(0.76,1.52)	0.57(0.08,1.06)
Z值^a		±1.70	±3.09	±3.29	±1.02
P值		0.090	0.002	0.001	0.310

表3 2组复杂腹壁疝患者术后不同时间VAS评分比较

组别	例数	术后第3天	术后1周	术后1个月	术后3个月
LH组	23	4.39(3.66,5.13)	2.87(2.23,3.51)	1.39(1.01,1.77)	0.57(0.09,1.05)
A	6	4.33(3.00,5.67)	2.67(1.76,3.67)	1.33(0.86,1.80)	0.50(0.00,1.00)
B	3	3.33(2.76,3.90)	2.33(1.39,3.27)	1.33(0.75,1.91)	0.33(0.00,0.76)
C	6	3.83(3.14,4.52)	2.50(1.54,3.46)	1.17(0.80,1.54)	0.33(0.00,0.76)
D	10	5.30(4.70,5.90)	3.50(3.00,4.00)	1.60(0.89,2.31)	0.80(0.00,1.60)
E	1	5.00	3.00	1.00	1.00
RH组	18	3.83(3.18,4.48)	2.11(1.67,2.56)	0.83(0.33,1.33)	0.39(0.00,0.78)
A	7	4.14(3.00,3.86)	2.14(1.57,2.71)	0.86(0.51,1.21)	0.43(0.00,0.86)
B	1	3.00	2.00	0.00	0.00
C	7	3.43(3.00,3.86)	2.00(1.47,2.53)	0.71(0.26,1.16)	0.29(0.00,0.72)
D	7	3.71(3.00,4.42)	2.29(1.54,3.04)	1.14(0.76,1.52)	0.57(0.08,1.06)
Z值^a		±1.70	±3.09	±3.29	±1.02
P值		0.090	0.002	0.001	0.310

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Short-term efficacy comparison between robot-assisted and laparoscopic surgery for complex abdominal wall hernias

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Short-term efficacy comparison between robot-assisted and laparoscopic surgery for complex abdominal wall hernias