国产机器人手术系统在肝门部胆管癌根治术中的应用价值  

Application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma

作　　者：翟翔宇 安宝坤 马德林 刘铭坤 张浩 杜刚[3] 李晓明 王伟[4] 靳斌 Zhai Xiangyu;An Baokun;Ma Delin;Liu Mingkun;Zhang Hao;Du Gang;Li Xiaoming;Wang Wei;Jin Bin(Department of Hepatobiliary Surgery,Second Hospital of Shandong University,Ji'nan 250001,China;Department of Hepatobiliary Surgery,Peking University People′s Hospital,Beijing 101100,China;Department of Organ Transplantation,Qilu Hospital of Shandong University,Ji'nan 250012,China;Shandong University Medical Integration and Practice Center,Ji'nan 250012,China)

机构地区：[1]山东大学第二医院肝胆外科,济南250001 [2]北京大学人民医院肝胆外科,北京101100 [3]山东大学齐鲁医院器官移植科,济南250012 [4]山东大学医学融合与实践中心,济南250012

出　　处：《中华消化外科杂志》2023年第S01期69-72,共4页Chinese Journal of Digestive Surgery

基　　金：山东省自然科学基金(ZR2023QH138);山东省重点研发计划重大创新工程(2022CXGC010502)

摘　　要：目的探讨国产机器人手术系统在肝门部胆管癌(hCCA)根治术中的应用价值。方法采用回顾性描述性研究方法。收集2022年11月山东大学第二医院收治的1例hCCA患者的临床病理资料;男性,66岁。采用图迈^(®)Toumai^(®)腔镜手术机器人系统行hCCA根治术。观察指标:(1)术中情况。(2)术后情况。(3)随访情况。计数资料以绝对数和(或)百分数表示。结果(1)术中情况。患者顺利完成机器人手术系统hCCA根治术,术中全程应用机器人手术系统完成肿瘤切除、淋巴结清扫、消化道重建;手术时间为400 min,术中出血量为100 mL,未进行术中输血。(2)术后情况。患者于术后1 d下床活动;术后4 d进食流质食物;术后5 d复查肝功能提示胆红素水平下降,行腹部CT检查提示无胆漏、肠漏,吻合口无水肿、坏死;术后7 d和9 d分别拔除胆肠吻合口前和吻合口后引流管;术后10 d出院。术后组织病理学检查结果示胆管中⁃低分化腺癌,CK7、CK19均为阳性,Ki⁃67阳性率为35%,胆管上下切缘均为阴性,肿瘤长径为30 mm,神经侵犯为阳性,肿瘤切缘为阴性,阳性淋巴结2枚,肿瘤细胞为阳性,送检第8、12组及胃小弯侧淋巴结未见肿瘤细胞转移。(3)随访情况。患者完成出院后1、3、5个月随访。患者随访期间肝功能恢复至正常水平,腹部CT检查提示无胆瘘、肠瘘、胃瘫等并发症及肿瘤转移。结论国产机器人手术系统可应用于hCCA根治术。Objective To investigate the application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma(hCCA).Methods The retrospective and descriptive study was constructed.The clinicopathological data of a 66-year-old male patient with hCCA who was admitted to the Second Hospital of Shandong University in November 2022 were collected.Radical resection of hCCA was performed using the Toumai® laparoscopic surgical robot system.Observation indicators:(1)intraoperative conditions;(2)postoperative conditions;(3)follow-up.Count data were represented as absolute numbers and(or)percentages.Results(1)Intraoperative conditions.The patient underwent radical resection of hCCA successfully using robotic surgical system,including tumor resection,lymph node dissection,and gastrointestinal reconstruction.The operation time and volume of intraoperative blood loss were 400 minutes and 100 mL,respectively,and no intraoperative blood transfusion was required.(2)Postoperative conditions.The patient began ambulation on postoperative day 1 and began taking liquid food on postoperative day 4.Liver function examination and abdominal computed tomograph(CT)on postoperative day 5 showed a decrease in serum bilirubin,no biliary or intestinal leakage,and no edema or necrosis at the anastomotic site.The abdominal pre-anastomotic and post-anastomotic drainage tubes were removed on the 7th and 9th day after the surgery respectively,and the patient was discharged on the 10th day after surgery.Results of postoperative pathological examination showed moderately to poorly differentiated adenocarcinoma of the bile duct.Immunostaining was positive for CK7 and CK19.The Ki-67 proliferation index was 35%.The proximal and distal resection margin of bile duct were negative.The tumor diameter was 30 mm.Perineural invasion was positive.The surgical specimen margin was negative.Two lymph nodes were identified containing tumor cells positive for malignancy.No tumor cell metastasis was detected in the No.8,No.12 or gastric lesser

关 键 词：胆道肿瘤 肝门部 机器人手术系统 疗效 应用价值 

分 类 号：R735.8[医药卫生—肿瘤]