达芬奇机器人手术系统在肝切除手术中的应用  

Application of the Da Vinci robot-assisted surgical system in hepatectomy

作　　者：陈燕凌[1] 蔡欣然[1] 陈江枝[1] 李戈 林圣哲 洪海杰[1] 潘韡[1] 孟泽武[1] CHEN Yanling;CAI Xinran;CHEN Jiangzhi;LI Ge;LIN Shengzhe;HONG Haijie;PAN Wei;MENG Zewu(Department of Hepatobiliary Surgery,Fujian Medical University Union Hospital/Fujian Institute of hepatobiliary Surgery/Fujian Medical University Cancer Center,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院肝胆外科·福建省肝胆外科研究所·福建医科大学肿瘤中心,福建福州350001

出　　处：《机器人外科学杂志（中英文）》2021年第2期133-142,共10页Chinese Journal of Robotic Surgery

基　　金：国家临床重点专科建设项目(普通外科)[卫办医政函(2012)649号];福建省微创医学中心建设项目[闽卫医政函(2017)171号]。

摘　　要：目的:探讨达芬奇机器人手术系统在肝切除手术中应用的可行性、安全性和优势。方法:回顾性分析2016年3月~2019年3月福建医科大学附属协和医院应用达芬奇机器人手术系统和腹腔镜手术系统对182例肝脏疾病患者进行肝切除治疗的临床资料。结果:所有患者手术均获成功,机器人组(80例)行半肝切除9例,肝叶切除25例,肝段和局部切除46例,其中2例中转开腹,手术时间为(126±5)min,失血量为(128±15)ml,10例术中进行输血;术后无腹腔内出血并发症,2例出现胆汁漏,1例出现肝周积液,5例出现腹水,2例出现肺炎;术后平均住院时间为9d。腹腔镜组(102例)行半肝切除25例,肝叶切除23例,肝段和局部切除54例,其中3例中转开腹,平均手术时间为(133±5)min,平均失血量为(149±10)ml,15例术中进行输血;术后2例出现腹腔内出血,3例出现胆汁漏,2例出现肝周积液,9例出现腹水,6例出现肺炎;术后平均住院时间为10d。两组术中和术后指标相比,差异均无统计学意义(P>0.05)。但在手术过程中,处理肝断面肝静脉破口或门静脉破口用Prolene线进行缝合修补时,机器人组比腹腔镜组所需时间明显缩短[(1.2±0.04)min Vs (3.2±0.03)min,P<0.0001;(1.8±0.03)min Vs (3.6±0.05)min,P<0.0001]。同样,在处理肝静脉断端或胆管残端进行缝合时,机器人组比腹腔镜组所需时间亦明显缩短[(1.5±0.03)min Vs (3.0±0.03)min,P<0.0001;(2.2±0.03)min Vs (3.6±0.02)min,P<0.0001]。在解剖游离左/右肝蒂等第一肝门结构时,机器人组比腹腔镜组所需时间更短[(4.1±0.08)min Vs (4.3±0.05)min,P=0.025]。结论:达芬奇机器人在肝切除手术方面与腹腔镜肝切除具有相似的安全性和有效性,且手术相关并发症发生率相近。Objective:To evaluate the feasibility,safety and advantages of the Da Vinci robot-assisted surgical system in hepatectomy.Methods:The clinical data of 182 patients with liver diseases who underwent operations by Da Vinci robot-assisted surgical system and laparoscopy system from March 2016 to March 2019 were analyzed retrospectively.Results:All the surgeries were operated successfully.In the robot group(80 cases),9 cases were underwent hemihepatectomy,25 cases underwent lobectomy,46 cases underwent segmental and local hepatectomy,of which 2 cases were converted to laparotomy.The operation time was 126±5 min,the blood loss was 128±15 ml,and 10 cases were given intraoperative blood transfusion.There were no complications of intraperitoneal hemorrhage.Bile leakage were found in 2 cases,perihepatic effusion in 1 case,ascites in 5 cases,pneumonia in 2 cases,with the average hospital stay of 9 d.In the laparoscopic group(102 cases),25 cases were treated with hemi-hepatectomy,23 cases with lobectomy,54 cases with segmental and local hepatectomy,of which 3 cases were converted to laparotomy.The average operation time was 135±5 min,and the average blood loss was 149±10 ml.15 cases were transfused during the operation,2 cases had intraperitoneal hemorrhage,3 cases had bile leakage,2 cases had perihepatic effusion,9 cases had ascites and 6 cases had pneumonia.The average hospital stay was 10 d.There were no significant differences between the two groups.However,when using Prolene suture to repair the hepatic vein break or portal vein break during the operation,less time costs in the robot group than that in the laparoscopic group(1.2±0.04 Vs 3.2±0.03,P<0.0001 and 1.8±0.03 Vs 3.6±0.05,P<0.0001).In the same way,less time costs in the robot group for suturing the stumps of hepatic vein and bile duct than that in the laparoscopic group(1.5±0.03 Vs 3.0±0.03,P<0.0001 and 2.2±0.03 Vs 3.6±0.02,P<0.0001,respectively).When dissecting the first hilar structure such as the left/right hepatic pedicle,less time needed in the

关 键 词：机器人手术系统 腹腔镜手术 肝切除 肝肿瘤 

分 类 号：R608[医药卫生—外科学] R656