经第三空间达芬奇机器人内镜联合手术治疗胃黏膜下肿瘤  

Robotic and endoscopic cooperative surgery in the third space for the resection of gastric submucosal tumors

作　　者：石承昕 厉英超[2] 孙琪 时飞宇 李亚光 于田雨 秦倩 吴宏 王光辉 佘军军 Shi Chengxin;Li Yingchao;Sun Qi;Shi Feiyu;Li Yaguang;Yu Tianyu;Qin Qian;Wu Hong;Wang Guanghui;She Junjun(Department of General Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Gastroenterology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院普通外科,710061 [2]西安交通大学第一附属医院消化内科,710061

出　　处：《中华普通外科杂志》2019年第11期952-955,共4页Chinese Journal of General Surgery

基　　金：西安交通大学第一附属医院重大新医疗新技术项目(XJYFY-2017W44);西安交通大学第一附属医院临床项目(XJTU1AF-3D-2O17-006、XJTU1AF-CRF-2015-029);国家自然科学基金(81870380、81702362);国家博士后科研流动站(2018M631176)。

摘　　要：目的评价在胃壁"第三空间"内进行达芬奇机器人内镜联合手术切除胃黏膜下肿瘤的可行性和治疗效果。方法回顾性分析2017年8月至2018年2月西安交通大学第一附属医院联合手术切除胃黏膜下肿瘤的4例患者和行腹腔镜楔形切除术的19例患者。结果所有行联合手术患者均实现R0切除,手术时间与传统手术组相比差异有统计学意义[(112±29)min比(93±11)min,t=2.338,P<0.05];出血量与传统手术组相比差异有统计学意义[(11±6)ml比(59±6)ml,t=15.102,P<0.01];肿瘤大小/切除标本大小与传统手术组相比差异有统计学意义[(65.4%±28.2%)比(22.8%±19.6%),t=3.680,P<0.05]。术后首次经肛门通气时间分别为(3±1.4)d比(4.1±0.9)d,差异无统计学意义(t=2.026,P>0.05);术后住院时间分别为(6.5±1.3)d比(8.5±0.6)d,差异有统计学意义(t=4.902,P<0.01);住院费用分别为(57651±10097)元和(42620±5086)元,差异有统计学意义(t=4.508,P<0.01)。术后随访患者3个月,均未出现肿瘤复发。结论"第三空间"内达芬奇机器人内镜联合手术是一种手术时间短、出血量少、术后恢复较好并且较为安全可行的新术式。Objective To evaluate combined robotic and endoscopic surgery in the third space for gastric submucosal tumors(SMTs).Methods Combined surgery in 4 patients were compared with 19 patients who underwent laparoscopic wedge resection between Aug 2017 and Feb 2018.Results R0 resection was achieved in all combined surgery patients.The operation time was longer(112±29)min vs.(93±11)min(t=2.338,P<0.05),but less blood loss,(11±6)ml vs.(59±6)ml(t=15.102,P<0.01).In combined surgery group,there was a larger tumor over resected tissue percentage,65.4%±28.2%vs.22.8%±19.6%(t=3.680,P<0.05).Combined surgery group patients were with earlier first breaking wind(3±1.4)d vs.(4.1±0.9)d(t=2.026,P>0.05),and shorter hospital stay(6.5±1.3)d vs.(8.5±0.6)d(t=4.902,P<0.01),but a little higher hospitalization costs(57651±10097)rmb vs.(42620±5086)rmb(t=4.508,P<0.01).There were no major postoperative complications occurred in neither groups,nor tumor recurrences after 3-month follow-up.Conclusion Combined robotic and endoscopic surgery in the third space for submucosal gastric tumors is a novel operation with short operation time,less blood loss and good result.

关 键 词：胃肿瘤 机器人 腹腔镜 

分 类 号：R73[医药卫生—肿瘤]