机器人肝尾状叶切除  

Robot-assisted caudate lobectomy

作　　者：王宏光[1] 纪文斌[1] 

机构地区：[1]解放军总医院肝胆外科全军肝胆外科研究所,北京100853

出　　处：《中华肝脏外科手术学电子杂志》2017年第3期181-186,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家科技支撑计划(2012BAI06B01)

摘　　要：目的探讨机器人肝尾状叶切除的可行性、安全性及其手术技巧。方法回顾性分析2009年7月至2012年5月在解放军总医院行机器人肝尾状叶切除的7例患者临床资料。其中男6例,女1例;年龄36~65岁,中位年龄51岁;肝门部胆管癌5例,尾状叶肝细胞癌合并肝门部胆管癌栓1例,肝内胆管细胞癌1例。患者均签署知情同意书,符合医学伦理学规定。腹壁建立6个Trocar,植入达芬奇机器人手术系统,行肝尾状叶切除,整个手术过程不需要Pringle法阻断入肝血流。结果除1例以Hybrid完成手术,其余6例均以全机器人方式成功完成手术,无中转开腹。其中联合右半肝切除4例,联合左半肝切除2例,联合肝右三叶切除1例。手术时间中位数为694(600~720)min,失血量为1 360(400~3 000)ml,5例术中输血。1例术后18 d死于肝衰竭。4例术后出现并发症,其中2例胆漏,1例胆漏合并下肢深静脉血栓,均保守治愈;1例术后2 d因肝动脉瘤破裂出血经开腹动脉瘤切除重建治愈。术后住院时间为15(9~19)d。结论机器人肝尾状叶切除是安全、可行的,其拓展了腹腔镜肝切除的适应证,有利于精准的肝门部解剖和腹腔镜下缝合,尤其适合肝门部胆管癌肝尾状叶切除。Objective To investigate the feasibility, safety and surgical techniques of robot-assisted caudate lobectomy. Methods Clinical data of 7 patients who underwent robot-assisted caudate lobectomy in the PLA General Hospital between July 2009 and May 2012 were retrospectively analyzed. Among them, 6 cases were males and 1 female, aged 36-65 years old with a median age of 51 years old. Five cases were diagnosed with hilar cholangiocarcinoma, 1 with hepatocellular carcinoma in caudate lobe complicated with hilar cholangiocarcinoma thrombus, and 1 with intrahepatic cholangiocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Six Trocars were created at the abdominal wall and the da Vinci surgical system （DVSS） was implanted. The caudate lobectomy was performed without occlusion of hepatic blood inflow by Pringle method. Results Except 1 patient underwent surgery with Hybrid, the other 6 patients successfully underwent surgery only with DVSS. No conversion to laparotomy was observed. Among the surgery, 4 cases were combined with right lobe resection, 2 cases with left lobe resection and 1 case with extented right hepatectomy. The median operation time was 694（600-720） min. The blood loss was 1 360（400-3 000） ml. Five cases received blood transfusion during surgery. One case died of liver failure 18 d after surgery. Postoperative complications were observed in 4 patients. Among them, 2 cases of bile leakage and 1 of bile leekage complicated with deep venous thrombosis in the lower extremity were all cured after conservative therapy, and 1 case of hemorrhage caused by ruptured hepatic artery aneurysm 2 d after surgery was cured by open resection and reconstruction of aneurysm. The postoperative length of hospital stay was 15（9-19） d. Conclusions Robot- assisted caudate lobectomy is safe and feasible, which broadens the indications of laparoscopic hepatactomy and is beneficial to precise hilar dissection and laparoscopic suture, especially for

关 键 词：胆管肿瘤 机器人 肝切除术 肝尾状叶切除 肝门部胆管癌 

分 类 号：R735[医药卫生—肿瘤]