达芬奇机器人手术系统辅助腹腔镜胰十二指肠切除术联合门静脉切除及人工血管架桥重建  

Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein resection and artificial vascular graft and reconstruction

作　　者：郑树国[1] 李建伟[1] 肖乐[1] 别平[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所中国人民解放军西南肝胆外科医院重庆,400038

出　　处：《中华消化外科杂志》2016年第4期390-394,共5页Chinese Journal of Digestive Surgery

摘　　要：目的探讨达芬奇机器人手术系统辅助腹腔镜胰十二指肠切除术联合门静脉切除及人工血管架桥重建的应用价值。方法采用回顾性描述性研究方法。收集2015年11月第三军医大学西南医院收治的1例胰头癌合并十二指肠、胆道梗阻患者的临床资料。术中见患者门静脉受侵犯较长，肿瘤周围血管增生，遂行达芬奇机器人手术系统辅助腹腔镜胰十二指肠切除术联合门静脉切除及人工血管架桥重建。观察患者手术时间、术中出血量、术中输血情况、术后拔除引流管时间，术后并发症发生情况，术后病理学检查结果、术后住院时间及随访结果。采用门诊及电话方式进行随访，观察患者术后生存情况。随访时间截至2016年2月。结果患者成功行达芬奇机器人手术系统辅助腹腔镜胰十二指肠切除术联合门静脉切除及人工血管架桥重建。患者术中切除门静脉长度约3cm。手术时间为670min，术中出血量为600mL，输RBC悬液400mL、血浆200mL。术后1d下床活动，术后3d拔除胃管，进食流质食物，术后8d拔除腹腔引流管。患者术后未出现并发症，复查CT示门静脉主干通畅，无明显狭窄及充盈缺损。术后病理学检查示胰头部腺鳞癌；手术切除标本十二指肠近、远端切缘及胰腺切缘均为阴性。患者术后12d出院。术后随访3个月，患者生存情况良好。结论达芬奇机器人手术系统辅助腹腔镜胰十二指肠切除术联合门静脉切除及人工血管架桥重建治疗胰头癌合并十二指肠、胆道梗阻安全可行，近期疗效较好。Objective To explore the application value of Da Vinci robot-assisted laparoseopic pancreati- coduodenectomy combined with portal vein （PV） resection and artificial vascular graft and reconstruction. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with cancer of pancreatic head combined with biliary and duodenal obstructions who was admitted to the Southwest Hospital of the Third Military Medical University in November 2015 were collected. Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction were applied to the patient due to intra- operative tumor extensive invasion to the PV and angiogenesis around the tumor. The operation time, volume of intraoperative blood loss and transfusion, time of postoperative drainage-tube removal, postoperative complications, result of postoperative pathological examination, duration of postoperative hospital stay and results of follow-up were observed. The follow-up of outpatient examination and telephone interview was performed to detect the survival of the patient up to February 2016. Results The patient underwent successful Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction. The length of intraoperative excisional PV, operation time, volume of intraoperative blood loss, volume of red blood cell suspen- sion and blood plasma infusions were 3 cm, 670 minutes, 600 mL, 400 mL and 200 mL, respectively. The patient got out-off-bed activity at postoperative day 1 and fluid diet intake after gastric-tube removal at postoperative day 3, and drainage-tube was removed at postoperative day 8. No postoperative complication was detected. The patient had unblocked main PV without obvious stenosis and filling defect by computer tomography rescanning. Adenosquamous carcinoma of the pancreatic head was confirmed by postoperative pathological examination. There were negative resection mar

关 键 词：胰头部肿瘤 胰十二指肠切除术 门静脉切除 重建 达芬奇机器人手术系统 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤] TP242[医药卫生—临床医学]