机器人辅助单孔腹腔镜实施妇科恶性肿瘤手术技巧的探讨  

Studies on the robot-assisted single port laparoscopic surgery of gynecological malignant tumors

作　　者：高京海 张育佼 金志军 刘晓军 GAO Jing-hai;ZHANG Yu-jiao;JIN Zhi-jun;LIU Xiao-jun(Department of Obstetrics and Gynaecology, Changzheng Hospital, Naval Medical University, Shanghai 200003, China)

机构地区：[1]海军军医大学附属长征医院妇产科

出　　处：《解放军医学杂志》2019年第7期615-619,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨利用3代SI级达芬奇机器人辅助单孔腹腔镜治疗妇科恶性肿瘤的手术技巧。方法回顾性分析2018年6-8月于海军军医大学附属长征医院妇产科行机器人辅助单孔腹腔镜手术治疗的8例妇科恶性肿瘤患者的临床资料。患者年龄34~51(43±6)岁;体重指数(BMI)20.1~26.3(23.2±3.1) kg/m^2;8例患者中,4例为早期子宫内膜癌,4例为早期宫颈癌。采用3代SI级达芬奇机器人手术系统,借助普通机器人系统的多孔器械及Lagiport单孔多通道平台完成机器人辅助经脐单孔腹腔镜手术,4例早期子宫内膜癌患者行全子宫+双附件切除+前哨淋巴结活检术,4例早期宫颈癌患者行宫颈癌根治术。结合既往研究及手术操作实践,对单孔机器人手术方案制定及单孔机器人手术操作技巧进行探讨。结果 8例患者均成功实施机器人辅助单孔腹腔镜手术,无一例另行辅助穿刺孔,无一例中转开腹,手术时间为(208±68) min,术中出血量为(155±71) ml,术中无输尿管、膀胱、直肠及闭孔神经损伤及输血发生。术后无输血、持续发热、伤口渗液、盆腹腔感染及深静脉血栓等并发症发生。4例早期子宫内膜癌患者术后4 d出院,4例早期宫颈癌患者术后7 d出院。术后所有患者均对伤口情况满意。结论 3代SI级达芬奇机器人借助普通机器人多孔器械及Lagiport单孔多通道平台辅助经脐单孔腹腔镜手术,是治疗妇科恶性肿瘤的有效手术方法之一。Objective To explore the technique of single port laparoscopy assisted by the third generation SI class Da Vinci robot in treatment of gynecological malignant tumors.Methods The clinical data were retrospectively analyzed of 8 patients with robot-assisted single port laparoscopy of gynecological malignant tumor from June to August 2018 in Changzheng Hospital.Of the 8 patients [aged 34–51(43±6) years and BMI of 20.1–26.3(23.2±3.1) kg/m^2],4 were early endometrial cancer and another4 were early cervical cancer.With the help of porous instruments of ordinary robot system and Lagiport single-site multi-channel platform,the third generation SI class Da Vinci robotic surgical system was used to complete the robot assisted transumbilical single port laparoscopic surgery.Four patients with early endometrial cancer received total hysterectomy + double-adnexy resection +sentinel lymph node biopsy,and another 4 with early cervical cancer received radical resection of cervical carcinoma.Results Robot assisted single port laparoscopic surgery was successfully performed in all 8 patients with no additional auxiliary puncture port or laparotomy.The operation time was(208±68) min,and the intraoperative blood loss was(155±71) ml.No injury of ureter,bladder,rectum and obturator nerve and blood transfusion occurred during operation.No postoperative complications occurred such as blood transfusion,persistent fever,wound exudation,pelvic and abdominal infection and deep venous thrombosis.Four patients with endometrial cancer were discharged 4 days after operation,and another 4 with cervical cancer were discharged 7 days after operation.All patients were satisfied with the wound after operation.Conclusion The third generation SI-class Da Vinci robot can complete gynecological malignant tumor surgery with the help of ordinary robot instruments and Lagiport single-site multi-channel platform,which is one of the effective surgical methods for gynecological malignant tumor.

关 键 词：腹腔镜 机器人手术 生殖器肿瘤 女(雌)性 单孔机器人 单孔多通道穿刺器 手术技巧 

分 类 号：R713.4[医药卫生—妇产科学]