达芬奇机器人在妇科手术应用中的安全性评价  

Safety evaluation on Da Vinci surgical system in gynecological surgery

作　　者：齐金红[1] 袁勇[1] 冯文娟[1] 孙薇 刘丽颖[1] 周丽萌[1] QI Jinhong;YUAN Yong;FENG Wenjuan;SUN Wei;LIU Liying;ZHOU Limeng(The 2nd Department of Gynecologic Oncology,Jilin Province Cancer Hospital,Changchun 130012,China)

机构地区：[1]吉林省肿瘤医院妇瘤二科,吉林长春130012

出　　处：《机器人外科学杂志（中英文）》2021年第2期111-122,共12页Chinese Journal of Robotic Surgery

基　　金：吉林省科技发展计划项目(20190303179SF)。

摘　　要：目的:探讨达芬奇机器人手术行妇科手术的安全性、可行性及临床应用价值。方法:回顾性分析吉林省肿瘤医院于2014年10月~2019年7月完成的达芬奇机器人妇科手术患者286例的临床资料,其中恶性肿瘤183例,良性手术103例。恶性肿瘤中,99例宫颈癌,82例子宫内膜癌,1例卵巢癌,1例阴道癌。评估所有患者的临床指标,包括手术时间、术中失血量、术后肠道功能恢复时间、膀胱功能恢复时间、腹部切口愈合时间;分析恶性肿瘤患者的淋巴结切除数目、术后并发症发生情况(出血、感染、尿潴留、肠梗阻、下肢深静脉血栓等)、总住院时间等;通过检测所有手术患者血清C反应蛋白(CRP)和白介素-6(IL-6)浓度的变化判断手术对机体炎症反应的影响。结果:286例患者手术均顺利完成,无中转开腹,无术中大出血、脏器损伤等严重并发症。手术时间34~280min,平均(148.7±97.8)min;出血量0~170ml,平均(83±69)ml;术后肠道功能恢复时间为6~68h,平均(35.3±19.6)h;膀胱功能恢复时间10~504h;术后72h引流量9~376ml,平均(198.3±79.4)ml;引流管留置时间49~296h,平均(187.9±74.8)h;术后腹部切口拆线78~128h,平均(96.3±10.6)h;恶性肿瘤切除淋巴结切除数目7~46枚,平均(33.4±7.3)枚;住院时间85~678h,平均(304.5±107.3)h。术后感染发生6例,肠梗阻5例,血栓性并发症4例,1例单侧小腿肌间静脉血栓,1例左侧腘静脉血栓,1例PICC置管处头静脉血栓性静脉炎,1例术后5个月(放化疗)出现右小腿肌间静脉血栓,经溶栓、抗凝治疗好转;术后发生淋巴囊肿24例,其中14例出现不同程度的外阴水肿,经对症处置后均恢复良好。于术后24h测定C反应蛋白浓度为39.8~220.3mg/L,平均(109.47±38.79)mg/L;术后5d浓度为4.7~21.4mg/L,平均(19.58±5.63)mg/L。术后24h测定白介素-6浓度为10.2~18.9ng/L,平均(14.57±3.94)ng/L;术后5d浓度为3.7~12.4ng/L,平均(6.51±2.74)ng/L。结论:达芬奇机器人应用于妇科手�Objective:To investigate the safety,feasibility and clinical application value of Da Vinci surgical system in gynecological surgery.Methods:The clinical data of 286 patients underwent Da Vinci robotic surgery in Jilin Province Cancer Hospital from October 2014 to July 2019 was retrospectively analyzed.Results:All the surgeries were successfully completed without conversion to open surgery,no massive hemorrhage or organ damage was found.The operation time was 34 min to 280 min,the mean operation time was(148.7±97.8)min.The bleeding volume was 0 ml to 170 ml,with mean bleeding volume of(83±69)ml.The recovery time of intestinal function after surgery was 6 h to 68 h,with average recovery time of(35.3±19.6)h.The recovery time of bladder function was 10 h to 504 h.The volume of drainage was 9 ml to 376 ml 72 hours after surgery,with average volume of(198.3±79.4)ml.The drainage tube indwelling time was 49 h to 296 h,with mean time of(187.9±74.8)h.Stitch removing time of abdominal incision was 78 h to 128 h,with an average time of(96.3±10.6)h.The number of lymph node resections for malignant tumor resection was 7 to 46,with an average of(33.4±7.3).Hospital stay was 85 h to 678 h,with an average of(304.5±107.3)h.6 cases of postoperative infection,5 cases of intestinal obstruction,4 cases of thrombotic complications,1 case of unilateral calf intermuscular venous thrombosis,1 case of left iliac vein thrombosis,and 1 case of venous thrombosis of PICC catheter were found.1 case of thrombophlebitis caused by PICC tube dwelling.1 cases of venous thrombosis on the right calf muscle 5 months after chemoradiotherapy,which improved after thrombolysis and anticoagulation.24 cases of postoperative lymphadenopathy were found,among which 14 cases of vulval edema in different degrees happened and all recovered well after symptomatic treatment.In the above cases,the C-reactive protein concentration was measured at 39.8 mg/L to 220.3 mg/L 24 hours after surgery,with an average of(109.47±38.79)mg/L.The concentration was 4.7 mg/L

关 键 词：达芬奇机器人 妇科手术 安全性 

分 类 号：R608[医药卫生—外科学] R713[医药卫生—妇产科学]