达芬奇机器人联合淋巴示踪在进展期远端胃癌根治术中的应用  

Application of da Vinci Robot Combined With Lymphatic Tracer in Radical Gastrectomy for Advanced Gastric Cancer

作　　者：王晓鹏[1] 郭进[1] 李渊[1] 史浩[1] 车杨[1] 苏河[1] 郭天康[1] Wang Xiaopeng;Guo Jin;Li Yuan(General Surgery Clinical Center, Gansu Provincial Hospital, Lanzhou 730000, China)

机构地区：[1]甘肃省人民医院普外临床中心,兰州730000

出　　处：《中国微创外科杂志》2018年第3期225-229,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：甘肃省人民医院科研基金(16GSSY2-5)

摘　　要：目的探讨达芬奇机器人联合淋巴示踪技术在进展期远端胃癌根治术中的应用效果。方法回顾性分析2016年6月~2017年6月72例进展期远端胃癌患者临床资料,根据患者自身经济状况及自愿选择分为达芬奇+纳米碳组24例,开腹手术+纳米碳组20例,开腹手术组(无术中淋巴结示踪)28例。对3组淋巴结检出情况、术后资料进行比较。结果达芬奇+纳米碳组检出淋巴结(28.9±5.3)枚/例,明显高于开腹手术+纳米碳组(24.6±5.5)枚/例(P=0.006)及开腹手术组(20.2±4.5)枚/例(P=0.000);达芬奇+纳米碳组检出淋巴结黑染率75.9%(527/694),黑染淋巴结的肿瘤阳性率为27.1%(143/527),与开腹手术+纳米碳组(27.0%,103/382)无统计学差异(χ2=0.003,P=0.954)。达芬奇+纳米碳组出血量(162.5±84.0)ml,明显少于开腹手术+纳米碳组(227.0±53.9)ml(P=0.005)和开腹手术组(208.9±76.0)ml(P=0.026);3组手术时间、术后吻合口或残端漏、术后出血、淋巴漏发生率无统计学差异(P>0.05)。达芬奇+纳米碳组术后排气时间(2.2±0.6)d,明显早于开腹手术+纳米碳组(3.7±1.3)d(P=0.000)和开腹手术组(4.0±1.2)d(P=0.000)。达芬奇+纳米碳组术后48 h疼痛评分(0.40±0.16)分,明显低于开腹手术+纳米碳组(1.33±0.18)分(P=0.000)和开腹手术组(1.36±0.20)分(P=0.000)。达芬奇+纳米碳组术后住院时间(9.5±3.5)d,明显短于开腹手术+纳米碳组(15.4±4.9)d(P=0.000)和开腹手术组(16.2±4.8)d(P=0.000)。开腹手术+纳米碳组术中严重副损伤发生率最高(P=0.015)。结论达芬奇联合纳米碳在进展期胃癌根治术淋巴结清扫中操作安全可行,创伤小,患者术后恢复快;在淋巴结清扫方面,纳米碳具有良好的淋巴结示踪效果,淋巴结检出数量明显提高。Objective To investigate the clinical effect of carbon nanoparticle lymphatic tracer in da Vinci robot-assisted radical gastrectomy for advanced gastric cancer.Methods Clinical data of72patients with advanced gastric cancer who were admitted to our hospital from June2016to June2017were analyzed retrospectively.They were divided into three groups by the patients,wishes and their own economic situation:The robot with carbon nanoparticle group(n=24),the laparotomy with carbon nanoparticle group(n,=20),and laparotomy group(n,=28,without intraoperative lymph node tracing).Comparison of the results of harvested lymph nodes and the postoperative data were made.Results The number of harvested lymph nodes in the robot with carbon nanoparticle group(28.9±5.3)was significantly higher than that in the laprascopy with carbon nanoparticle group(24.6土5.5,P=0.006)and laparotomy group(20.2±4.5,P=0.000).The rate of black-dyed harvested lymph node was75.9%(527/694)and the metastasis rate of black-dyed lymph nodes was27.1%(143/527)in the robot with carbon nanoparticle group,without significant difference compared to the laparotomy with carbon nanoparticle group[27.0%(103/382),=0.003,P=0.954].The bleeding volume of the robot with carbon nanoparticle group[(162.5±84.0)ml]was less than that of laparotomy with carbon nanoparticle group[(227.0±53.9)ml,P=0.005]and laparotomy group[(208.9±76.0)ml,P=0.026].There was no statistical difference among the three groups in terms of operation time,postoperative anastomotic stoma or stump leakage,incidence of postoperative bleeding,and incidence of lymphatic leakage(P>0.05).The time to postoperative passage of gas in the robot with carbon nanoparticle group[(2.2±0.6)d]was significantly earlier than that in the laparotomy with carbon nanoparticle group[(3.7±1.3)d,P=0.000]and the laparotomy group[(4.0±1.2)d,P=0.000].The postoperative48h pain score in the robot with carbon nanoparticle group[(0.40±0.16)points]was significantly lower than that in the laparotomy with carbon nanoparticle group

关 键 词：达芬奇机器人手术系统 纳米碳 胃癌根治术 淋巴结 

分 类 号：R735.2[医药卫生—肿瘤]