达芬奇Xi系统在完全机器人根治性远端胃大部切除术中的应用  

Application of Da Vinci Xi robotic surgical system in full robotic radical distal gastrectomy

作　　者：王刚 潘华峰 刘江 王海峰 程伟 江志伟 WANG Gang;PAN Huafeng;LIU Jiang;WANG Haifeng;CHENG Wei;JIANG Zhiwei(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院普通外科,江苏南京210029

出　　处：《山东大学学报（医学版）》2020年第5期51-55,共5页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81500417);江苏省中医药局科技项目(JD201807)。

摘　　要：目的探讨达芬奇Xi系统应用于完全机器人根治性远端胃大部切除术的安全性和可行性。方法回顾性分析江志伟团队自2017年10月至2020年2月收治的完全达芬奇机器人根治性远端胃大部切除术患者的临床资料。所有患者淋巴结清扫和消化道重建均在镜下完成。其中采用达芬奇S系统行根治性远端胃大部切除手术患者63例(S系统组),采用达芬奇Xi系统行根治性远端胃大部切除手术患者39例(Xi系统组)。观察分析两组患者手术情况、术后恢复情况及术后并发症发生率。结果 102例患者均成功完成完全机器人根治性远端胃大部切除手术,无中转开腹患者。Xi系统组与S系统组患者术中出血量[(69.1±43.2)mL vs(84.2±48.9) mL,P=0.091]、淋巴结清扫数目[(31.4±8.9)枚vs(32.4±9.4)枚,P=0.357]差异无统计学意义。Xi系统组装机时间[(5.1±1.9)min vs(11.2±3.7)min,P<0.001]、手术时间[(206.2±45.3)min vs(221.5±42.3)min,P=0.013]短于S系统组;Xi系统组术中擦镜次数明显少于S系统组[(4.3±1.6)次vs(12.2±4.9)次,P<0.001]。两组患者术后恢复情况(术后首次下床活动时间、术后耐受半流质饮食时间、术后首次通气时间)差异无统计学意义,两组术后住院时间和并发症发生率差异无统计学意义。结论达芬奇系统应用于根治性远端胃大部切除术是安全可行的,可以利用其优势完成缝合、打结等精细操作,新一代达芬奇机器人Xi系统利用其更佳的80°内窥镜可视范围、更加灵活的机械臂,以及悬吊式平台,显著节省了手术时间。Objective To investigate the safety and feasibility of Da Vinci Xi robotic surgical system in full robotic radical distal gastrectomy. Methods The clinical data of patients treated with Da Vinci robotic surgical system in full radical distal gastrectomy by Jiang Zhiwei?s team during Oct. 2017 and Feb. 2020 were retrospectively analyzed. Lymph node dissection and digestive tract reconstruction were performed under microscope in all patients. Radical distal gastrectomy with Da Vinci S system was performed in 63 patients(S system group), and radical distal gastrectomy with Da Vinci Xi system was performed in 39 patients(Xi system group). The operation situation, postoperative recovery and complications were recorded. Results All operations were successful, with no conversion to open surgery. There were no significant differences in intraoperative blood loss [(69.1±43.2)mL vs(84.2±48.9) mL, P=0.091] and number of lymph node dissection [(31.4±8.9) vs(32.4±9.4), P=0.357] between Xi system group and S system group. Xi system had significantly shorter machine assembly time [(5.1±1.9) min vs(11.2±3.7) min, P<0.001], shorter operation time [(206.2±45.3) min vs(221.5±42.3) min, P=0.013], and lower intraoperative lens cleaning frequency [(4.3±1.6) times vs(12.2±4.9) times, P<0.001] than S system. There were no significant differences in time to first off-bed activity, time to recover semiliquid diet, time to first flatus, postoperative length of stay and incidence of complications between the two groups. Conclusion The Da Vinci system is safe and feasible for radical distal gastrectomy, and can be used to perform accurate surgical manipulations such as suture and knotting. The new Da Vinci robotic Xi system has a better endoscope view of 80°, more flexible robotic arm and a suspended platform, which can significantly save surgical time.

关 键 词：胃肿瘤 达芬奇机器人系统 根治性远端胃切除 

分 类 号：R61[医药卫生—外科学]