“达芬奇”机器人手术系统在胆道恶性疾病微创手术中的应用  

Application of Da Vinci surgical system in the surgery of biliary malignancy diseases

作　　者：张煊[1] 王宏光[1] 纪文斌[1] 童俊翔[1] 罗英[1] 刘哲[1] 芦芳[1] 顾万清[1] 董家鸿[1] 

机构地区：[1]解放军总医院肝胆外科医院全军肝胆外科研究所,北京100853

出　　处：《中华肝胆外科杂志》2013年第7期503-506,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家科技支撑计划2012BA106801

摘　　要：目的探讨达芬奇机器人手术系统在胆道恶性疾病微创手术中应用的可行性、安全性及优势。方法回顾性分析了2009年3月至2013年3月解放军总医院应用达芬奇机器人手术系统对19例胆道恶性疾病微创手术患者的临床资料。结果除1例中转开腹外，所有患者均通过该系统成功完成手术。其中实施大范围肝切除11例，肝十二指肠韧带淋巴结清扫17例，胆肠吻合14例。手术时间为（504±194）min（210～720rain）。术中失血量20～3000ml，输血5例。i例因术后肝衰竭于术后18d死亡。术后并发症5例（26．3％），其中3例为一过性胆漏，自愈；i例为术后门静脉狭窄，行二次开腹手术门静脉切除重建后治愈；I例为肝固有动脉假性动脉瘤破裂出血，行二次开腹手术动脉瘤切除、动脉端端吻合后治愈。术后平均住院时间14．7d。结论达芬奇机器人手术系统能够安全有效地完成各类胆道恶性疾病的微创外科手术，尤其对复杂的胆道重建手术优势更明显，但对于联合大范围肝切除的肝门部胆管癌根治术，其技术系统还需进一步优化。Objective To evaluate the application of the Da Vinci surgical system for malignant biliary disease. Methods Between March 2009 and March 2013, 19 patients with malignant biliary diseases underwent robotic biliary surgeries at the PLA General Hospital and were analyzed retrospec- tively. Results The robotic surgeries were performed successfully on 18 patients and 1 was converted to open surgery. Among the 19 surgeries, 11 patients underwent major hepatectomies, 17 patients un- derwent a radical lymphodenectomy and 14 patients underwent an Roux-en-Y hepaticojejunostomy. The mean operative time was （504±194） minutes. Intraoperative blood loss ranged from 20 to 3000 ml and blood transfusions were required in 5 patients. 1 patient died of liver failure at day 18 postopera tion. The postoperative morbidity rate was 26.3~ （5 cases）. These complications included 3 transient bile leakages, 1 portal vein stenosis and 1 hepatic artery pseudoaneurysm. Both patients with the por- tal vein and hepatic artery complications received the stenosis and pseudoaneurysm resection with vas- cular reconstruction. The mean postoperative hospital stay was 14.7 days. Conclusions The minimally invasive surgery for malignant biliary diseases was safe and feasible when assisted by the Da Vinci sur- gical system, and there was a potential ascendancy in the procedures which required an endoscopic re construction of the biliary tract. However, the procedures and surgical techniques should be refined for hilar cholangiocarcinoma due to its higher complication rate.

关 键 词：达芬奇机器人手术系统 外科手术 微创性 胆道 

分 类 号：R657.4[医药卫生—外科学]