机器人手术系统在老年结直肠肿瘤患者手术中的应用  

Robotic surgery for colorectal cancer in elderly patients

作　　者：许平平[1] 韦烨[1] 许剑民[1] 

机构地区：[1]上海复旦大学附属中山医院普通外科,200032

出　　处：《中华胃肠外科杂志》2016年第5期499-501,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市卫生系统重要疾病联合攻关项目（2013ZYJB-0011）

摘　　要：机器人手术特有的优点是3D图像清晰和操作稳定灵活，缺点是缺乏力反馈和费用昂贵以及手术耗时长；但其对结直肠肿瘤、尤其是老年患者在减少术中创伤应激和术后恢复等短期效果方面具有显著优势。结直肠肿瘤是老年人常见的肿瘤疾病，75岁以上老年人全身功能储备降低，并合并多种内科系统疾病。上海复旦大学附属中山医院普通外科自2011年3月开展了第1例77岁男性机器人直肠低位前切除术后，截至2015年10月，共施行老年人达芬奇机器人结直肠肿瘤手术24例，平均年龄77．8岁；男性18例，女性6例；降结肠及乙状结肠肿瘤14例，直肠肿瘤10例；有19例肿瘤直径〉5cm，16例为溃疡型肿瘤：合并高血压患者14例．冠心病6例，糖尿病4例，脑血管病3例。有22例行机器人直肠低位前切除术，2例行机器人腹会阴联合直肠癌根治术：术中平均出血量为85ml；手术时间为（123．1±45．2）min，清扫淋巴结平均12．4枚／例．病理检查结果显示，TNM分期I期患者为3例，Ⅱ期为10例，Ⅲ期为11例。术后除出现尿路感染1例、腹腔感染1例和出现心房颤动伴快速心室率1例外，其他患者恢复良好。术后肛门排气时间平均2．8d。本中心临床疗效证明，机器人手术对老年结直肠肿瘤患者是安全可行的。随着最先进的第4代机器人手术系统面世和先进手术模拟器研发等多方面的进步，机器人手术系统将在结直肠肿瘤手术的治疗中发挥更重要的作用。The outstanding advantages of robotic surgery include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of factile feedback, high cost and prolonged surgery time. It was reported that robotic surgery was associated with less trauma stress and faster recovery in elderly patients （〉175 years old） when compared with open surgery. Elderly people have a higher incidence of carcinogenesis and also have more comorbidities and reduced functional reserve. Clinical data of patients over 75 years old treated by robotic surgery in Zhongshan Hospital affiliated to Fudan University from March 2011 to October 2014 were analyzed retrospectively. A total of 24 consecutive patients were included with a median age of 77.8 years old. There were 18 male and 6 female patients. Among them, 14 patients were diagnosed with descending and sigmoid colon cancers while 10 with rectal cancers; 19 had tumor size larger than 5 cm; 16 were diagnosed with ulcerative adenocarcinoma. Fourteen patients were complicated with hypertension, 6 with cardiopulmonary diseases, 4 with diabetes mellitus and 3 with cerebrovascular diseases. Twenty-two patients underwent low anterior resection and 2 abdominoperineal resection. The estimated blood loss was 85 ml; the median operation time was （123.1 ± 45.2） min; the median number of retrieved lymph node was 12.4. Postoperative pathologic results showed that 3 patients were stage 1 , 10 stage Ⅱ , and Ⅱ stage Ⅲ. Postoperative complication was observed in 3 patients： urinary infection in 1 case, intraperitoneal infection in 1 case and atria fibrillation in 1 case, respectively. Median time to first postoperative flatus was 2.8 days. Our results indicated that robotic surgery is safe and feasible in the elderly patients. The next generation of robotic system may make up for these deficiencies through new technologies. With the advantage of more advanced surgical simulator, robotic surgery will play a more important role in the tre

关 键 词：机器人手术系统 结直肠肿瘤 老年 

分 类 号：R735.34[医药卫生—肿瘤] TP242[医药卫生—临床医学]