达芬奇机器人手术系统在肝门部胆管癌根治术中的应用价值  

Application value of Da Vinci robotic surgical system in radical resection of perihilar cholan-giocarcinoma

作　　者：唐勇[1] 孙释然 柴楚星 施申超[1] 钦琦[1] 李民[1] 熊俊[1] 万赤丹[1] Tang Yong;Sun Shiran;Chai Chuxing;Shi Shenchao;Qin Qi;Li Min;Xiong Jun;Wan Chidan(Department of Hepatobiliary Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430020,China)

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430020

出　　处：《中华消化外科杂志》2022年第1期129-134,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金面上项目(81771718)。

摘　　要：目的探讨达芬奇机器人手术系统在肝门部胆管癌(pCCA)根治术中的应用价值。方法采用回顾性描述性研究方法。收集2018年9月至2021年3月华中科技大学同济医学院附属协和医院收治的10例行达芬奇机器人手术系统pCCA根治术患者的临床病理资料;男6例,女4例;年龄为(58±7)岁。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用电话和门诊方式进行随访,了解患者生存情况和肿瘤复发情况。随访时间截至2021年6月。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:10例患者均顺利完成达芬奇机器人手术系统pCCA根治术,无中转开腹和术中输血患者。10例患者手术时间为(465±87)min,术中出血量为(167±81)mL。10例患者中,1例BismuthⅢb型手术标本切缘阳性,9例为R0切除。(2)术后情况:10例患者胃管拔除时间为(2.3±1.9)d,术后住院时间为(19.9±9.0)d。10例患者中,无二次手术和围手术期死亡。10例患者中,6例发生围手术期并发症,其中5例发生胸腔积液,3例发生腹腔积液,1例发生肠梗阻,部分患者合并多种并发症。上述并发症经对症保守治疗后,患者胸腔积液、腹腔积液消失,肠梗阻好转。10例患者术后均未发生出血、胆瘘、肠瘘等严重并发症。(3)随访情况:10例患者均获得随访,随访时间为3~20个月,中位随访时间为11个月。随访期间,10例患者中,3例肿瘤复发,复发位置为残肝肝内胆管,腹腔其余位置未发生种植转移。7例肿瘤未复发患者中,1例因消化道出血、多器官功能衰竭死亡。10例患者中,9例生存。结论达芬奇机器人手术系统用于pCCA根治术可行。Objective To investigate the application value of Da Vinci robotic surgical system in radical resection of perihilar cholangiocarcinoma(pCCA).Methods The retrospective and descrip-tive study was conducted.The clinicopathological data of 10 patients undergoing Da Vinci robotic radical resetion of pCCA in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from September 2018 to March 2021 were collected.There were 6 males and 4 females,aged(58±7)years.Observtaion indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.The patients were followed up by telephone interview and outpatient service to detect survival of patients and tumor recurrence up to June 2021.Measurement data with normal distribution were expressed as Mean±SD,and measurement data with skewed distribu-tion were represented as M(range).Count data were represented as absolute numbers.Results(1)Surgical situations:10 patients underwent Da Vinci robotic radical resection of pCCA succe-ssfully,without conversion to laparotomy or intraoperative blood transfusion.The operation time of 10 patients was(465±87)minutes,and the volume of intraoperative blood loss was(167±81)mL.Of the 10 patients,1 case of Bismuth typeⅢb had a positive surgical margin and the remaining 9 cases had R0 resection.(2)Postoperative situations:the time to gastric tube extraction was(2.3±1.9)days,and the duration of postoperative hospital stay of the 10 patients was(19.9±9.0)days.Among the 10 patients,there was no second operation or perioperative death.Of the 10 patients,6 cases had perioperative complications,including 5 cases wth pleural effusion,3 cases with peritoneal effusion,and 1 case with intestinal obstruction,some patients had multiple complications.After symptomatic conservative treatment,pleural effusion and peritoneal effusion disappeared and intestinal obstruction was improved.None of the 10 patients had serious complica-tions such as bleeding,biliary fistula or intestinal fistula.(3)Follow-up:10 patients were f

关 键 词：胆管肿瘤 肝门部 达芬奇机器人手术系统 胆道重建 微创技术 

分 类 号：R735.8[医药卫生—肿瘤]