比较机器人外科手术系统与腹腔镜肝切除治疗肝细胞癌的初步结果  

Robot-assisted surgery versus laparoscopic liver resection for hepatocellular carcinoma:a comparison of short term outcomes

作　　者：樊嘉[1] 周俭[1] 王鲁[1] 王晓颖[1] 任宁[1] 贺轶锋[1] 叶青海[1] 汤钊猷[1] 

机构地区：[1]复旦大学附属中山医院肝外科,上海200032

出　　处：《上海医学》2011年第1期15-18,共4页Shanghai Medical Journal

基　　金：国家科技重大专项(2008ZX10002);上海市教育委员会教育发展基金会曙光计划(07SGC4)

摘　　要：目的通过与腹腔镜肝切除治疗肝细胞癌的结果进行比较,初步总结机器人外科手术系统辅助肝切除手术的技术特点、安全性及初步疗效。方法 2010年1-10月,应用机器人外科手术系统辅助肝切除手术(机器人组)治疗3例肝细胞癌患者,均伴不同程度肝硬化,肿瘤均为单发,分别位于Ⅲ段(2例)、Ⅵ段(1例),并与同期完成的腹腔镜肝切除治疗的15例肿瘤大小、位置相似的肝细胞癌患者(腹腔镜组)进行比较。结果机器人组的中位肿瘤直径为3mm(2.0～3.5cm),腹腔镜组为4cm(1.7～9.0cm)。机器人组的中位手术时间为120min(90～180min),腹腔镜组为150min(100～220min)。机器人组的中位术中出血量为100mL,腹腔镜组为75mL,两组各有1例患者术中输血。腹腔镜组有1例患者中转开腹手术。机器人组术后中位住院时间为5d(4～6d),腹腔镜组为6d(4～8d)。机器人组无手术并发症发生,腹腔镜组有1例因术后双侧胸腔积液而需引流。随访至今腹腔镜组有1例发生肝内复发。结论初步结果显示,对周边型(如Ⅱ、Ⅲ、、Ⅵ段)肝细胞癌患者,机器人外科手术系统辅助肝切除手术的治疗效果与腹腔镜肝切除相似。Objective To develop the techniques for robotic hepatocellular carcinoma（HCC） resection and assess their feasibility,safety,and outcome by comparing with laparoscopic HCC resection.Methods From January 2010 to October 2010,three HCC patients underwent robotic resection at our department.All the 3 patients had solitary HCC（2 cases in segmentⅢand one inⅥ）,accompanied by liver cirrhosis.These patients were compared with 15 patients who underwent laparoscopic resection of similar tumors.Results The tumor size was similar in both groups（robotic 3 cm,2.0-3.5 cm vs.laparoscopic 4 cm,1.7—9.0 cm）.The mean operative time was 120 min（90- 180 min） in the robotic vs.150 min（100—220 min） in the laparoscopic group. There was no difference between the two groups regarding the estimated blood loss and blood transfusions. Conversion to an open operation was only necessary in one patient in the laparoscopic group.Complications were observed in one patient in the laparoscopic group.The mean postoperative hospital stay was 5 d（4—6 d） in robot group vs.6 d（4—8 d） in laparoscopic group.One case in laparoscopic group had intrahepatic recurrence during follow-up.Conclusion The results of present study suggest that a robotic approach can provide similar operative outcomes to laparoscopic liver resection for selected HCC patients.

关 键 词：机器人外科手术系统 腹腔镜 肝切除 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]