达芬奇机器人在胰腺手术中的应用  

Application of the da Vinci robot in pancreatic surgery

作　　者：崔鑫涛 王骥 马红钦 刘利 杜羽升 赵文星 CUI Xintao;WANG Ji;MA Hongqin(Department of General Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院普通外科,江苏徐州221000

出　　处：《腹腔镜外科杂志》2024年第8期594-601,606,共9页Journal of Laparoscopic Surgery

摘　　要：目的:分析达芬奇机器人在胰腺微创手术中的安全性与可行性。方法:回顾分析2019年12月至2022年12月接受达芬奇机器人胰腺手术的42例患者的临床资料,并与同期149例腹腔镜胰腺手术进行对比。机器人组中10例行胰十二指肠切除术,24例行胰体尾切除术,5例行胰腺肿瘤局部切除术,3例行胰腺中段切除术;腹腔镜组中98例行胰十二指肠切除术,31例行胰体尾切除术,2例行胰腺肿瘤局部切除术,18例行胰腺中段切除术。结果:胰十二指肠切除术中,机器人组手术时间长于腹腔镜组[(383.2±69.6)min vs.(307.1±73.2)min,P<0.05],术后排气时间短于腹腔镜组[(3.1±0.7)d vs.(4.0±1.0)d,P<0.05];两组B+C级胰瘘(0 vs. 10.2%)、术后出血(10.0%vs. 4.1%)、术后淋巴瘘(10.0%vs. 5.1%)、腹腔感染(0 vs. 5.1%)、肺部感染(0 vs. 4.1%)发生率差异均无统计学意义(P>0.05)。胰体尾切除术中,机器人组术中出血量少于腹腔镜组[(106.7±59.6)mL vs.(168.1±90.9)mL,P<0.05],术后排气时间短于腹腔镜组[(3.5±0.9)d vs.(4.7±1.3)d,P<0.05];两组B+C级胰瘘(8.3%vs. 9.7%)、腹腔感染(4.2%vs. 9.7%)、切口感染(4.2%vs. 0)发生率差异均无统计学意义(P>0.05)。良性或交界性肿瘤手术中,机器人组保脾率高于腹腔镜组(65.0%vs. 34.6%,P=0.041)。结论:机器人胰腺手术是安全、可行的,并发症发生率与腹腔镜手术相当,在胰体尾手术保脾率、术后首次排气时间方面具有一定优势。Objective:To analyze the safety and feasibility of da Vinci robot in minimally invasive pancreatic surgery.M ethods:The clinical data of 42 patients who underwent da Vinci robotic pancreatic surgery from Dec.2019 to Dec.2022 were retrospectively analyzed and compared with 149 laparoscopic pancreatic minimally invasive surgeries in the same period.In the robotic group,there were 10 cases of pancreaticoduodenectomy,24 cases of distal pancreatectomy,5 cases of local resection of pancreatic tumor,and 3 cases of mid-pancreatic resection;in the laparoscopic group,there were 98 cases of pancreaticoduodenectomy,31 cases of distal pancreatectomy,2 cases of local resection of pancreatic tumor,and 18 cases of mid-pancreatic resection.Results:In pancreaticoduodenectomy,the operation time in the robotic group was longer than that in the laparoscopic group[(383.2±69.6)min vs.(307.1±73.2)min,P<0.05];and the postoperative exhaust time was s horter than that in the laparoscopic group[(3.1±0.7)d vs.(4.0±1.0)d,P<0.05];in the two groups,B+C grade pancreatic fistula(0 vs.10.2%),postoperative hemorrhage(10.0%vs.4.1%),postoperative lymphatic fistula(10.0%vs.5.1%),abdominal infection(0 vs.5.1%),and pulmonary infection(0 vs.4.1%)incidences were not statistically significantly different(P>0.05).In distal pancreatectomy,intraoperative blood loss in the robotic group was less than that in the laparoscopic group[(106.7±59.6)mL vs.(168.1±90.9)mL,P<0.05],and postoperative exhaust time was shorter than that in the laparoscopic group[(3.5±0.9)d vs.(4.7±1.3)d,P<0.05].The differences in the incidence of grade B+C pancreatic fistula(8.3%vs.9.7%),abdominal infection(4.2%vs.9.7%),and incision infection(4.2%vs.0)were not statistically significant(P>0.05).In benign or borderline tumor surgery,the spleen preservation rate was higher in the robotic group than that in the laparoscopic group(65.0%vs.34.6%,P=0.041).Conclusions:Robotic pancreatic surgery is safe and feasible,with a complication rate comparable to laparoscopic pancreatic surgery,and h

关 键 词：胰腺肿瘤 胰体尾切除术 胰十二指肠切除术 机器人手术 

分 类 号：R657.5[医药卫生—外科学]