术中超声在机器人胰腺肿瘤精准切除中的应用  

Application of intraoperative ultrasound in robot-assisted precise resection of pancreatic tumors

作　　者：李征 刘文生 卓奇峰 史逸华 吉顺荣 虞先濬 徐晓武 LI Zheng;LIU Wensheng;ZHUO Qifeng;SHI Yihua;JI Shunrong;YU Xianjun;XU Xiaowu(Department of Pancreatic Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Pancreatic Cancer Institute,Shanghai Key Laboratory of Precision Medicine for Pancreatic Cancer,Pancreatic Cancer Institute,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院胰腺外科,复旦大学上海医学院肿瘤学系,上海市胰腺肿瘤研究所,上海市胰腺肿瘤精准诊疗重点实验室,复旦大学胰腺肿瘤研究所,上海200032

出　　处：《中国普通外科杂志》2024年第9期1368-1376,共9页China Journal of General Surgery

基　　金：上海市卫生健康委员会卓越基金资助项目(20224Z0006);上海市卫生健康委员会卫生行业临床研究专项基金资助项目(20234Y0119);国家自然科学基金资助项目(82403205);上海市科学技术委员会扬帆专项基金资助项目(22YF1409000)。

摘　　要：胰腺良性和低度恶性肿瘤的发病率和检出率逐年升高,对于该类肿瘤患者,传统的根治性规则切除术式,会损失过多正常胰腺组织,导致患者术后胰腺内外分泌功能不足等并发症。研究已证实,微创剜除或局部切除等保留功能手术,可以最大限度保护患者胰腺功能,并改善远期生活质量。然而,对于一些深入胰腺实质的肿瘤,如何准确定位肿瘤并保护好胰管是个难题。术中超声(IOUS)因其便携性、可提供实时高分辨率信息、不使用电离辐射以及不需要特殊的患者准备等优势,成为理想的术中成像工具,被称为外科医生的“第三只眼”。随着技术的进步,IOUS的应用范围已超出最初有限的诊断作用,扩展到各种手术应用,包括识别不可触及的病灶、指导手术策略和对肿瘤进行分期等。在当前微创和精准手术时代,外科医生能否熟练使用IOUS成为一个重要的问题。本文回顾IOUS的应用历史,总结机器人IOUS的优点和基本使用方法,并分享IOUS在机器人胰腺肿瘤精准切除中的应用技巧。The incidence and detection rates of benign and low-grade malignant pancreatic tumors have risen yearly.For patients with such tumors,traditional radical resection procedures often result in excessive loss of normal pancreatic parenchyma,leading to complications such as postoperative insufficiency of both exocrine and endocrine functions.Studies have shown that functional-preserving surgeries,such as minimally invasive enucleation or partial resection surgeries,can maximize the protection of patients'pancreatic function and improve long-term quality of life.However,for some tumors deep within the pancreatic parenchyma,accurately locating the tumor and protecting the pancreatic duct pose challenges.Intraoperative ultrasound(IOUS)has become an ideal intraoperative imaging tool,often referred to as the surgeon's"third eye"because of its portability,ability to provide real-time high-resolution information,non-reliance on ionizing radiation,and the fact that it does not require special patient preparation.With advancements in technology,the application scope of IOUS has expanded beyond its initially limited diagnostic role to various surgical applications,including identifying non-palpable lesions,guiding surgical strategies,and staging tumors.In the current era of minimally invasive and precision surgery,the proficiency of surgeons in using IOUS has become an important issue.This article reviews the history of IOUS applications,summarizes the advantages and basic usage methods of robotic IOUS,and shares techniques for applying IOUS in robot-assisted precise resection of pancreatic tumors.

关 键 词：胰腺肿瘤 保留实质切除 术中超声 机器人手术 

分 类 号：R735.9[医药卫生—肿瘤]