达芬奇机器人辅助腹腔镜下子宫颈残端癌根治术联合盆腔淋巴结切除术1例报告  

Robot-assisted Laparoscopic Radical Trachelectomy Combined with Pelvic Lymphadenectomy for Cervical Stump Cancer:A Case Report

作　　者：黄柯[1] 叶明侠[1] 李立安[1] 范文生[1] 李亚里[1] 宋磊[1] 赵恩锋[1] 孟元光[1] 

机构地区：[1]解放军总医院妇产科,北京100853

出　　处：《中国微创外科杂志》2014年第9期830-833,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨达芬奇机器人手术系统治疗子宫颈残端癌的安全性和可行性。方法术前放置输尿管支架,采用达芬奇机器人手术系统,常规建立气腹,于脐右上方45°10 cm处放置机器人腹腔镜镜头,平脐右侧腋前线处放置第一机械臂,于脐左上方45°10 cm处放置第2机械臂,机械臂孔与镜头孔呈等腰三角形,镜头孔处为等腰三角形顶点。患者左侧腋前线平髂前上棘上方5 cm处建立助手操作孔,同时该操作孔连接气腹机。常规切除盆腔淋巴结,以输尿管支架为指示,鉴别输尿管与膀胱和子宫颈的解剖关系,完成根治性残端子宫颈切除。结果机械臂安装时间30 min,手术操作时间110 min,术中出血量300 ml。术后24 h下地活动,36 h肛门排气。因病理结果提示淋巴血管间隙侵犯,术后14 d开始行辅助化疗。术后随访1个月,无不适,输尿管支架术后1个月取出。结论达芬奇机器人辅助腹腔镜手术治疗子宫颈残端癌安全、可行。Objective To investigate the safety and feasibility of da Vinci robotic surgical system for the treatment of cervical stump cancer . Methods Ureteral stents were introduced into the bilateral ureters preoperatively .The pneumoperitoneum was established routinely .The da Vinci robotic surgical system was used .The laparoscopic camera was placed 10 cm from the umbilicus at the direction 45°upper right.The first operative arm was located at navel level on the right anterior axilary line , and the second was placed at the site 10 cm from the umbilicus at the direction 45°upper left.The sites of camera and two operative arms composed of an isosceles triangle . The assistant hole , which was connected with pneumoperitoneum apparatus , was located 5 cm above the anterosuperior iliac spine on the patient＇s left anterior axillary line .Pelvic lymphadenectomy was performed routinely .And under the guidance of ureteral stents, the anatomy surrounding the ureters, especially the bladder and cervix, was distinguished.Afterwards, the radical trachelectomy was accomplished . Results The time for mounting the operative arms was 30 min.The operative time was 110 min, and the intraoperative blood loss was 300 ml.The patient started to move on ground at the 24 h postoperatively , and her gastrointestinal tract functions recovered at the 36 h postoperatively .Because lymphovascular invasion （ LVI ） was diagnosed by postoperative pathological examination , we prescribed paclitaxel plus carboplatin as chemotherapy from the 14 day after the operation . Postoperative follow-up for 1 month found no discomfort . The ureteral stents were removed 1 month after the operation . Conclusion Robot-assisted laparoscopic radical trachelectomy for cervical stump cancer is safe and feasible .

关 键 词：机器人手术系统 子宫颈残端癌 腹腔镜 

分 类 号：R737.33[医药卫生—肿瘤] TP24[医药卫生—临床医学]