机器人辅助胰十二指肠切除术的学习曲线研究  

Learning curve of robot-assisted pancreatoduodenectomy

作　　者：袁亦挺 梁霄[1] YUAN Yiting;LIANG Xiao(Department of Hepatopancreatobiliary Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院肝胆胰外科,浙江杭州310000

出　　处：《机器人外科学杂志（中英文）》2024年第1期75-79,共5页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(82072625);浙江省重点研发计划(2021C03127)。

摘　　要：胰十二指肠切除术(Pancreaticoduodenectomy,PD)为目前治疗壶腹部周围、胰头部肿瘤的标准术式,但由于该手术涉及的周围器官及组织较多、范围广、消化系统重建难度系数高、术后并发症发生率及死亡率高等因素,PD一直被认为是胰腺外科难度最大的手术之一。近年来随着医疗器械的发展和技术的进步,微创胰十二指肠切除术在临床上得到了广泛使用。而达芬奇机器人手术系统在PD中的应用,使患者能够获得较好的临床预后。与传统腹腔镜手术对比,虽然机器人辅助胰十二指肠切除术(Robot-assisted Pancreaticoduodenectomy,RAPD)的手术时间增加,但术后住院时间及术中失血量明显降低,并且RAPD在淋巴结清扫数量、R0切缘获得率情况等方面也具有明显的优势。但RAPD对大部分胰腺外科医生而言难度较高,因PD术中重建有较多的吻合口,需进行大量的缝合和打结工作,这必然导致其学习曲线较其他术式明显增长。因此,RAPD学习曲线究竟需要完成多少病例?开展RAPD初始阶段的安全性和有效性能否得到保障?这些都是该术式普及过程中亟需探讨的问题。本文就目前国内外关于RAPD学习曲线的相关研究进行综述,以期为明确RAPD学习曲线提供一定的参考依据。Pancreaticoduodenectomy(PD)is currently a commonly used standard operation in the treatment of tumors around the ampulla and pancreatic head,since the operation involves many organs and tissues around the region,due to its wide scope,difficult reconstruction of digestive system,high postoperative complication rate and high mortality rate,PD has always been considered as one of the most difficult operations in pancreatic surgery.In recent years,with the development of medical devices and technology,minimally invasive pancreaticoduodenectomy has been widely used in clinical practice.The application of Da Vinci surgical system in PD has benefited many patients.Compared with the conventional laparoscopic surgery,robot-assisted pancreaticoduodenectomy(RAPD)could shorten the postoperative hospital stay and reduce intraoperative blood loss,although it has longer operative time.In addition,RAPD also has obvious advantages in the number of lymph node dissection and the rate of R0 resection margin.However,RAPD is still a challenge to most pancreatic surgeons,because there are many anastomoses to be reconstructed in the process of PD surgery,and a lot of suture and knot tying to do,which inevitably leads to a longer learning curve.Therefore,how many cases are needed to complete the RAPD learning curve,and whether the safety and effectiveness of the initial stage of RAPD can be guaranteed are still indeterminate for the popularization of this procedure.The current domestic and foreign researches on RAPD learning curve were summarized in this paper,hoping to provide a certain reference for clinically clarifying RAPD learning curve.

关 键 词：胰腺癌 胰十二指肠切除术 机器人手术系统 学习曲线 

分 类 号：R608[医药卫生—外科学] R656[医药卫生—临床医学]