机器人全结、直肠切除及回肠造口术治疗溃疡性结肠炎6例报告  

Robotic total proctocolectomy with ileostomy for ulcerative colitis:a retrospective analysis of six cases

作　　者：张小桥[1] 杨光[1] 李翠[1] 朱元庆[1] 安艳新[1] 吉棚[1] 杨同辉[1] 朱金明[1] 

机构地区：[1]济南军区总医院,山东济南250031

出　　处：《腹腔镜外科杂志》2017年第3期168-172,共5页Journal of Laparoscopic Surgery

基　　金：博士后基金面上项目(编号:2013M542475)

摘　　要：目的:探讨机器人全结、直肠切除及回肠造口术治疗溃疡性结肠炎的应用价值及手术技术。方法:回顾分析2012年7月至2016年12月接受机器人全结、直肠切除及回肠造口术的6例溃疡性结肠炎患者的临床资料,统计分析手术时间、机器人与患者对接时间、医生控制台操作时间及手术并发症等指标。结果:6例手术均应用达芬奇Si手术机器人完成,无中转开腹或中转腹腔镜手术。前4例手术采用6孔或7孔法操作,后2例手术简化为5孔法操作。术中需要2次变换体位与机器人床旁操作系统位置,共计3次人机对接。手术时间259~650 min,平均(409±132)min;其中人机对接时间30~128 min,平均(53±37)min,医生控制台操作时间142~370 min,平均(214±87)min。出血量平均(175±144)ml。后5例手术时间、出血量等均明显少于第1例手术。术后患者恢复顺利3例发生会阴部切口感染,1例患者术后3个月时回肠造口狭窄,经再次手术治愈。结论:应用达芬奇手术机器人,采用"五孔三步法"行完全机器人全结、直肠切除、回肠造口术安全、可靠,易于操作,是溃疡性结肠炎可供选择的手术方法。Objective：To evaluate the feasibility and technique of robotic total proctocolectomy with ileostomy for patients with ulcerative colitis.Methods：Six patients with ulcerative colitis were treated with robotic total proctocolectomy with ileostomy from Jul.2012 to Dec.2016.The medical records and operation videos were reviewed retrospectively.The durations of operation,estimated intraoperative blood loss,the docking time and surgeon console time were calculated,and the occurrence of complications were statistically analyzed.Results：All the six patients were treated with robotic total proctocolectomy with ileostomy without conversion to open or laparoscopic surgery.For the first 4 patients,six or seven ports technique was used,and for the last two,a simplified five-port technique was adopted.During the operation,additional twice dockings were essential as the patient cart of the da Vinci robot needed to be changed and the robot arms were repositioned.The average duration of operation was （409±132） min （ranged from 259 to 650 min）.The average docking time was （53±37） min （range,30-128 min） and the average surgeon console time was （214±87） min （range,142-370 min）.The average estimated blood loss was （175±144） ml.For the abovementioned indices,there were significant differences between the first case and the other 5 cases.The postoperative courses were uneventful.Surgical site infections occurred in the perineal incision of 3 patients.During the follow up of 1 to 55 months,one patient suffered from the stenosis of ileal stoma and was readmitted for a revisional surgery in 3 months after the first operation.Conclusions：Robotic total proctocolectomy with ileostomy,benefiting both the surgeon and the patient,is safe,reliable,feasible and effective for the surgical management of patients with ulcerative colitis.

关 键 词：结肠炎 溃疡性 全结直肠切除术 回肠造口术 机器人 

分 类 号：R656[医药卫生—外科学]