机器人胰腺手术适应证初探  

Experience in selecting patients to undergo robotic pancreatic surgery

作　　者：周桂华[1] 刘博[1] 夏红天[1] 陈明易[1] 王宏光[1] 纪文斌[1] 杨滔[1] 徐明月[1] 史海达 史宪杰[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853

出　　处：《中华肝胆外科杂志》2016年第3期180-183,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：军队十二五课题（CWS11J096）

摘　　要：目的通过大宗病例资料的回顾性分析，探讨达芬奇（DaVinci）机器人胰腺手术适应证及手术方式。方法系统性回顾总结2009年11月至2015年3月因胰腺良恶性疾病于解放军总医院住院行DaVinci机器人手术治疗的100例患者临床资料。结果100例中89例接受机器人辅助胰体尾切除术，5例行胰腺病灶局部切除，3例行胰腺中段切除，1例行胰十二指肠切除术，1例行胰肠吻合术，1例行胰胃吻合术。结论DaVinci机器人胰腺切除术是安全可行的。病灶局限且位于胰体尾实质内患者是机器人胰腺手术的最好适应证，可直接采用胰体尾切除术。对于位于胰腺外周表面且与周围组织及胰腺组织界限较为清晰的病灶可考虑采用剜除术；对于病灶位于胰腺峡部及胰体偏向于胰头侧实质内且无明显浸润表现的可以采用胰腺中段切除。对于病灶位于胰头的病例如欲行机器人胰十二指肠切除术治疗应该根据各个医学中心的经验而定。Objective ＂To review our initi＇al experience in selecting patients to undergo robotic pan- creatic surgery. Methods This is a retrospective study on 100 patients who underwent robotic pancreatic operations at the Chinese PLA General Hospital from September 2009 to March 2015. Results 89 patients underwent robotic pancreatic body and tail resection,5 patients superficial enucleation of pancreatic lesions, 3 patients middle pancreatic resection, 1 patient pancreaticoduodenectomy, 1 patient pancreatico-gastric ana- stomosis, and 1 patient pancreatico-jejunal anastomosis. Conclusions Robotic pancreatic surgery was safe and feasible. Lesions located in pancreatic body and tail could be treated with resection of pancreatic body and tail, and this appeared to be the best indication for robotic pancreatic surgery. Focal lesions on the sur- face of pancreas could be enucleated using the Da Vinci robotic surgical system. Extreme care should be exercised in selecting patients for robotic pancreaticoduodenectomy, because the surgical risk is high.

关 键 词：机器人手术系统 胰腺外科 适应证 

分 类 号：R657.5[医药卫生—外科学]