机器人肝胆胰手术的切除与重建  

Resection and Reconstruction of Robotic Hepatopancreatobiliary Surgery

作　　者：刘荣[1] 刘渠[1] LIU Rong;LIU Qu(Faculty of Hepatopancreatobiliary Surgery,the First Medical Center of Chinese People's Liberation Army(PLA)General Hospital,Beijing 100853,China)

机构地区：[1]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：《协和医学杂志》2023年第6期1125-1130,共6页Medical Journal of Peking Union Medical College Hospital

摘　　要：机器人手术系统的出现弥补了传统腹腔镜手术的不足,促进了微创手术的发展。然而在机器人肝胆胰手术发展初期,由于缺乏与机器人手术系统相适应和匹配的切除与重建技术,制约了该手术系统在肝胆胰手术中的应用。笔者通过总结前期经验,提出将主要血管作为标识,沿血管走形游离并切除血管周围软组织的环血管切除技术,以及通过减低重建过程中的组织张力和单位面积上的牵拉应力以提高重建质量的双低重建技术。此两项技术能够克服机器人手术系统操作空间小、缺乏力反馈等不足,有助于提高机器人手术的安全性,缩短术者的学习曲线,进一步扩大机器人手术适应证,从而促进机器人肝胆胰手术的推广和临床应用。Robotic system has overcome the limitations of traditional laparoscopy and promoted the de-velopment of minimally invasive surgery.However,in the early stage of robotic hepatopancreatobiliary surgery,the lack of resection and reconstruction technology compatible with the robotic system restricts its ap-plication.Based on the previous experience,we propose the circumvascular resection technique,which takes the main blood vessels as the mark,mobilizes the blood vessels and excises the soft tissues around the blood vessels,and the double-low reconstruction technique,which can improve the reconstruction quality by reduc-ing the tissue tension and the tensile stress per unit area during the reconstruction.These two techniques can address the limitations of the robotic system including limit operating space and lack of force feedback,and help to improve surgical safety,reduce learning curve and promote the clinical application of robotic hepato-pancreatobiliary surgery.

关 键 词：机器人手术 肝胆胰外科 环血管切除 低张力 低应力 重建手术 

分 类 号：TP242.6[自动化与计算机技术—检测技术与自动化装置] R615[自动化与计算机技术—控制科学与工程]