机器人手术系统在低位直肠癌保肛手术中的应用  

Application of robotic surgical system in sphincter- preserving surgery for low rectal cancer

作　　者：许平平[1] 许剑民[1] 

机构地区：[1]复旦大学附属中山医院结直肠外科,上海200032

出　　处：《中华胃肠外科杂志》2017年第6期606-609,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：机器人手术系统凭借三维图像清晰和操作稳定灵活的优势，已广泛应用于低位直肠癌保肛手术。其应用原则包括肿瘤的根治切除和功能的完整保留。机器人手术系统在低位直肠癌保肛手术的应用术式主要有：（1）低位直肠前切除术：其在观察盆腔神经、游离骶前及侧方时的优势明显，手术安全可行；保肛率高是其潜在优势，但术后恢复和远期生存的改善仍需进一步大样本验证。（2）经肛括约肌间切除术（ISR）：主要适用于直肠系膜游离后肿瘤下缘距肛管直肠环2 cm的T1、T2期肿瘤，由于其手术本身技术难度比较大，而机器人手术系统可完全经腹入路完成括约肌间切除，但术后肛门功能受影响，存在夜间粪便溢出之可能，故目前仍处于探索阶段。（3）经肛门直肠外翻出切除术（又称Welch手术）：国内外相关的应用报道较少，笔者单位至今（截至2017年3月）已完成51例机器人经肛门直肠外翻切除术，所有患者的手术均获成功，短期临床结局方面均取得满意效果，长期生存仍在随访中；我们认为，在严格把握适应证的情况下，该术式是安全可行的。展望其应用前景，由于机器人手术系统独特的能在狭小的盆腔空间快速精确地进行游离、切割、吻合等操作技术的优势，使得其对于低位直肠癌手术保肛率高，但与腹腔镜比较，其余方面未现明显优势。相信随着器械不断进步和大样本研究的开展，机器人手术系统将在低位直肠癌的治疗中发挥更重要的作用。Robotic surgical system has been widely applied in sphincter-preserving surgery for low rectal cancer with the advantages of clear 3D images and stably flexile manipulation. Its application principle includes radical resection of tumor and complete preservation of function. The main operation procedures of robotic surgical system in sphincter-preserving surgery for low rectal cancer are as follows： （1） Anterior resection of low rectal cancer： It is safe and feasible and has obvious advantages in observation of pelvic nerves, dissociation of presacral and sacral side, and high rate of sphincter-preserving, while the improvement of postoperative recovery and long-term survival needs to be verified by further large sample researches. （2） Per anus intersphincteric resection （ISR） ： It is mainly applied in T1 and T2 stage tumors with 2 cm distance from tumor low margin to anal edge after dissociation of mesorectum. The greater difficulty of manipulation is found in ISR, while robotic surgical system can complete the intersphincteric resection by transabdominal approach, but anal function may be affected with the possibility of feces spillage at night, so robotic ISR is now still in exploration stage. （3） Transanal everted pull-through resection （Welch resection） ： Associated application of this operation is rarely reported at home and abroad. Our department has completed 51 robotic procedures of Welch resection till March 2017. Welch resection is successfully performed in all the patients. The short-term clinical outcomes are quite satisfactory and long-term survival is followed up. We think that this procedure is safe and feasible under the strict mastering of indications. Owing to special manipulation advantages of quickly precise dissociation, cutting and anastomosis in small pelvic space, when compared to laparoscopic surgery, robotic surgical system has higher sphincter-preserving rate for low rectal cancer, however, no other advantages are found. We believe that with the development o

关 键 词：直肠肿瘤 低位 机器人手术系统 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]