达芬奇机器人盆腔廓清术在妇科肿瘤患者中的应用  

Clinical application of da Vinci robot-assisted pelvic exenteration in gynecological tumor patients

作　　者：王楠[1,2] 李立安 范文生[3] 马鑫[4] 刘洪一[5] 赵之明[6] 孟元光[1,3] Wang Nan;Li Lian;Fan Wensheng;Ma Xin;Liu Hongyi;Zhao Zhiming;Meng Yuanguang(Department of Obstetrics and Gynecology,The First Medical Center of PLA General Hospital,Bejing 100853,China;Medicine School of Chinese PLA,Beijing 100853,China;Faculty of Obstetrics and Gynecology,The Seventh Medical Center of the PLA General Hospital,Beijing 100007,China;Faculty of Urology,The Third Medical Center of the PLA General Hospital,Bejing 100039,China;Faculty of General Surgery,The First Medical Center of the PLA General Hospital,Bejing 100853,China;Faculty of Hepato-Pancreato-Biliay Surgery,The First Medical Center of the PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心妇产科,北京100853 [2]解放军医学院,北京100853 [3]解放军总医院第七医学中心妇产医学部,北京100007 [4]解放军总医院第三医学中心泌尿外科医学部,北京100039 [5]解放军总医院第一医学中心普通外科医学部,北京100853 [6]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2023年第2期91-95,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的分析达芬奇机器人盆腔廓清术(pelvic exenteration,PE)在妇科部分晚期癌、复发癌患者治疗中的应用价值。方法选取2014年9月至2021年12月期间解放军总医院第一医学中心妇产科诊治的19例接受机器人PE患者作为研究对象。总结并分析患者的一般资料、围手术期相关指标和随访情况;复习文献,讨论并分享相关经验。结果19例达芬奇机器人PE患者中,初治患者占21.05%、复发患者占78.95%;17例患者接受机器人多学科诊疗模式(multi disciplinary team,MDT)协作手术治疗,其中70.59%为两科联合手术、29.41%为三科联合手术;R0切除率为89.47%,先期化学药物治疗患者占52.63%,严重并发症发生率为10.53%。不同类型机器人PE分析比较,前盆腔PE占52.63%、后盆腔PE占31.58%、全盆腔PE占15.79%;三组的平均手术时间、肿瘤切除最大径、输血率、R0切除率、中转开腹率比较,差异无统计学意义(P>0.05);全盆腔PE组术中出血量最多,后盆腔PE组略少,前盆腔PE组最少[(700±444.41)mL比(375±271.57)mL比(147±86.16)mL,P=0.019];前盆腔PE组术后平均住院时间少于全盆腔PE组[(13.80±5.71)d比(22.33±5.13)d,P=0.046]。所有患者平均随访时间(33.05±25.73)个月,中位随访时间23个月;1年、2年总生存率分别为84.21%、63.16%。结论达芬奇机器人PE治疗部分晚期癌、复发癌患者疗效确切,合理把握手术指征、高水平的机器人手术MDT、科学的围手术期管理、个体化的综合治疗方案能够令更多患者获益。Objective To analyze the application value of da Vinci robot-assisted pelvic dissection in the treatment of some patients with advanced and recurrent cancer in gynecology.Methods 19 patients who received robot-assisted PE from the first medical center of the PLA General Hospital from Sep.2014 to Dec.2021 were selected as the study subjects.Analyze the general material of the cases,the relevant indicators in the perioperative period and the follow-up data.At the same time,review the literature and share relevant experience.Results Among 19 cases of da Vinci robot-assisted PE,21.05%were initially treated and 78.95%were relapsed.17 patients received robotic MDT cooperative surgery,70.59%of which were combined with two departments and 29.41%with three departments.The resection rate of R0 was 89.47%,the rate of neoadjuvant chemotherapy was 52.63%,and the rate of serious complications was 10.53%.Compared with different types of robot-assisted PE,anterior pelvic PE accounted for 52.63%,posterior pelvic PE accounted for 31.58%,and total pelvic PE accounted for 15.79%.There was no significant difference in average operation time,maximum diameter of tumor resection,blood transfusion rate,R0 resection rate and conversion rate among the three groups(P>0.05).The total pelvic PE group had the most surgical bleeding,the posterior pelvic PE group was slightly inferior,and the anterior pelvic PE group had the least[(700±444.41)mL vs(375±271.57)mL vs(147±86.16)mL,P=0.019].The average postoperative hospital stay in the anteriorr pelvic PE group was less than that in the total pelvic PE group[(13.80±5.71)days vs(22.33±5.13)days,P=0.046].The average follow-up time of all patients was(33.05±25.73)months,and the median follow-up time was 23 months;One-year and two-year OS were 84.21%and 63.16%respectively.Conclusions Da Vinci robot-assisted pelvic dissection has a definite effect on the treatment of some patients with advanced and recurrent cancer in gynecology.Reasonable control of surgical indications,high-level robotic surgica

关 键 词：机器人手术 盆腔廓清术 多学科团队 晚期癌 复发癌 

分 类 号：R737.3[医药卫生—肿瘤]