单中心学习曲线期机器人辅助胰腺手术50例临床分析  

Clinical analysis of 50 cases of robot-assisted pancreatic surgery during learning curve period in a single center

作　　者：黄俊甫 辛万鹏 易思清 涂书举 熊远鹏 姜海 万真[1] 肖卫东[1] HUANG Junfu;XIN Wanpeng;YI Siqing;TU Shuju;XIONG Yuanpeng;JIANG Hai;WAN Zhen;XIAO Weidong(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院普通外科,江西南昌330006

出　　处：《中国普通外科杂志》2024年第3期349-356,共8页China Journal of General Surgery

基　　金：江西省卫健委科技计划基金资助项目(202310238)。

摘　　要：背景与目的:自从2000年达芬奇机器人手术系统被批准应用于临床后,机器人辅助手术已在众多学科中广泛开展。由于胰腺和壶腹周围解剖结构的复杂性,相对于其他专业领域,机器人手术系统在胰腺外科中的应用起步要晚。尽管少数高流量的胰腺外科中心已积累上千例机器人辅助胰腺手术(RPS)的经验,但大多数单位仍处于学习曲线阶段。本研究对笔者所在中心学习曲线期RPS病例的临床疗效与经验进行总结,以期为临床提供参考信息。方法:回顾性分析南昌大学第一附属医院2020年1月—2022年9月间50例施行RPS患者的临床资料,其中胰十二指肠切除术(RPD) 23例,肿瘤剜除术(REN) 9例,胰体尾联合脾切除术(RDPS) 8例,中段胰腺切除术(RCP) 6例,保留十二指肠的胰头切除术(RDPPHR) 2例,保留脾脏的胰体尾切除术(RSPDP) 2例。所有手术由同一团队完成。结果:平均手术时间为(275±115) min,其中胰十二指肠切除术为(330±78) min,胰体尾联合脾切除术为(236±59) min。平均术中出血量(315±259) mL。总体并发症和临床相关胰瘘发生率分别为30.0%和10.0%。Clavien-Dindo并发症分级Ⅲ级以上并发症发生率6.0%(3/50),无术后30 d内死亡,中转率为4%,再手术率为2%。平均术后住院时间(13.2±7.7) d。全组恶性肿瘤(27例)患者平均获取淋巴结数为14 (4~34)枚。术后平均随访(23.4±9.3)个月,2例胰腺癌患者分别于术后12、14个月复发,其余患者均无肿瘤复发。结论:严格掌握手术适应证并充分借鉴成熟经验,在学习曲线期从易到难循序渐进开展RPS安全、可行。Background and Aims:Since the approval of the da Vinci robotic surgical system for clinical use in 2000,robot-assisted surgery has been widely adopted across various disciplines.Due to the complexity of pancreatic and periampullary anatomy,the application of robotic surgery systems in pancreatic surgery started later compared to other specialties.Although a few high-volume pancreatic surgery centers have accumulated experience with thousands of cases of robot-assisted pancreatic surgery(RPS),most units are still in the learning curve stage.This study was conducted to summarize the clinical efficacy and experience of RPS performed during the learning curve period in the authors' center,so as to provide reference information for clinical practice.Methods:The clinical data of 50 patients undergoing RPS in the First Affiliated Hospital of Nanchang University from January 2020 to September 2022 were retrospectively analyzed.Among them,there were 23 cases of pancreaticoduodenectomy,9 cases of tumor enucleation,8 cases of distal pancreatectomy with splenectomy,6 cases of central pancreatectomy,2 cases of duodenum-preserving pancreatic head resection,and 2 cases of spleen-preserving distal pancreatectomy.All surgeries were performed by the same team.Results:The mean operative time was(275±115) min,with(330±78) min for pancreaticoduodenectomy and(236±59) min for distal pancreatectomy with splenectomy.The average intraoperative blood loss was(315±259) mL.The incidence rates of overall complications and clinically relevant pancreatic fistula were 30.0% and 10.0%,respectively.The rate of Clavien-Dindo grade Ⅲ or above complications was 6.0%(3/50),with no deaths within postoperative 30 d,a conversion rate of 4%,and a reoperation rate of 2%.The mean length of postoperative hospital stay was(13.2±7.7) d.Among the malignant tumor patients(27 cases),the average number of lymph nodes retrieved was 14(4-34).The average follow-up period was(23.4±9.3) months,with two cases of pancreatic cancer recurrence at 12 and 14 months a

关 键 词：胰腺切除术 机器人手术 学习曲线 安全 

分 类 号：R657.5[医药卫生—外科学]