达芬奇机器人手术系统保留迷走神经胃癌根治术的临床疗效  

Clinical effect of vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer

作　　者：刘春阳[1] 郝迎学[1] 余佩武[1] 冯晨[1] 江宇星[1] 

机构地区：[1]第三军医大学西南医院全军普通外科中心微创胃肠外科中心,重庆400038

出　　处：《中华消化外科杂志》2017年第3期251-256,共6页Chinese Journal of Digestive Surgery

摘　　要：目的：探讨达芬奇机器人手术系统保留迷走神经胃癌根治术的安全性和可行性。方法：采用回顾性横断面研究方法。收集2015年1月至2016年11月第三军医大学西南医院收治的12例行达芬奇机器人手术系统保留迷走神经胃癌根治术患者的临床病理资料。患者均行达芬奇机器人手术系统保留迷走神经胃癌根治术，术中注意幽门上区、贲门右侧区域、胰腺上缘区域淋巴结清扫，其他操作同传统机器人手术系统胃癌手术。观察指标：（1）术中及术后情况：手术方式、消化道重建方式、手术时间、术中出血量、淋巴结清扫数目，术后病理学检查结果，术后胃肠功能恢复时间、进食流质饮食时间，术后住院时间，近期手术相关并发症（术后出血、吻合口瘘、梗阻及腹腔感染）。（2）随访情况：术后远期并发症（胃潴留、碱性反流性胃炎、倾倒综合征、胆囊病变、胆石症），术后生命质量（饮食情况、上腹部不适、恶心、呕吐、腹泻），术后营养状况（体质量、Hb、TP、Alb）及肿瘤复发情况。采用电话和门诊方式进行随访；电话随访患者了解患者饮食情况，消化道症状及体质量；门诊随访患者检测血常规、肝功能、肾功能、肿瘤标志物，行胸部X线片、腹部CT或彩色多普勒超声及胃镜等检查诊断肿瘤复发或转移情况。随访时间截至2016年12月。正态分布的计量资料以±s表示，偏态分布采用M（范围）表示。结果：（1）术中及术后情况：12例患者均成功施行达芬奇机器人手术系统保留迷走神经远端胃癌根治术，无中转腹腔镜及开腹手术，其中D1根治术 2例，D 1＋根治术2例，D2根治术8例；5例消化道重建行Billroth Ⅰ式吻合，7例行Billroth Ⅱ式吻合。12例患者手术时间为（247±34）min，术中出血量为（94±23）mL，淋巴结清扫数目为（27±7）枚。术后病理学检查显�Objective：To explore the safety and feasibility of vagus nervepreserving Da Vinci robot assisted radical gastrectomy for gastric cancer. Methods：The retrospective crosssectional study was conducted. The clinicopathological data of 12 gastric cancer patients who underwent vagus nervepreserving Da Vinci robot assisted radical gastrectomy at the Southwest Hospital of the Third Military Medical University from January 2015 to November 2016 were collected. All patients underwent vagus nervepreserving Da Vinci robotassisted radical gastrectomy for gastric cancer. During operation, lymph node dissection of the pyloric region, the right side of the cardia and the superior margin of the pancreas were noticed, and other surgical procedures were the same as the traditional Da Vinci robotassisted radical gastrectomy. Observation indicators： （1） intra and postoperative situations： surgical methods, digestive tract reconstruction, operation time, volume of intraoperative blood loss, number of lymph node dissected, results of postoperative pathological examination, recovery time of gastrointestinal function, time for liquid diet intake, duration of postoperative hospital stay, shortterm surgeryrelated complications （postoperative bleeding, anastomotic fistula, obstruction and intraabdominal infection）; （2） followup situations： postoperative longterm complications （gastric retention, alkaline reflux gastritis, dumping syndrome, gallbladder disease and cholelithiasis）, postoperative quality of life （diet, upper abdominal discomfort, nausea, vomiting and diarrhea）, postoperative nutritional status [body weight, hemoglobin （Hb）, total protein （TP）, albumin （Alb）] and tumor recurrence. Followup using telephone interview and outpatient examination was performed up to December 2016. Telephone interview included detecting diet of patients, digestive tract symptoms and body weight. Routine blood test, liver and kidney functions, tumor markers, chest Xray, abdominal computed tomography （CT） o

关 键 词：胃肿瘤 根治术 达芬奇机器人手术系统 保留迷走神经 

分 类 号：R735.2[医药卫生—肿瘤]