达芬奇机器人辅助全胃切除后离断式手工食管空肠吻合的临床研究  

Da Vinci robot assisted total gastrectomy plus hand-sewn esophagojejunostomy for gastric carcinaoma

作　　者：黄万博 谢建明 杨佳宾 殷永芳 丁海翔 俞秀冲[2] 严志龙[2] Huang Wanbo;Xie Jianming;Yang Jiabin;Yin Yongfang;Ding Haixiang;Yu Xiuchong;Yan Zhilong(Graduate School of Health Science Center,Ningbo University,Ningbo 315211,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Ningbo University,Ningbo 315000,China)

机构地区：[1]宁波大学医学部研究生院,宁波315211 [2]宁波大学附属第一医院胃肠外科,宁波315000

出　　处：《中华普通外科杂志》2024年第10期758-763,共6页Chinese Journal of General Surgery

基　　金：国家自然科学基金(82302611);浙江省医药卫生科技计划项目(2020KY813)。

摘　　要：目的评价机器人全胃切除后离断式手工缝合技术的安全性及可行性。方法回顾性分析2021年11月至2024年5月在宁波大学附属第一医院确诊为胃癌并行全胃切除术的72例患者的临床资料,根据手术方式分为机器人辅助全胃切除,手工缝合消化道重建(RATG)组30例,腹腔镜辅助全胃切除(LATG)组42例,采用体外吻合器消化道重建方案,分析两组患者的临床病理资料、围手术期指标及术后随访资料。结果72例患者均顺利完成手术,RATG组无中转开腹。RATG组的总手术时间长于LATG组[(235.2±25.8)min比(200.7±40.6)min,t=4.099,P<0.05)];在消化道重建时间、术后进食流质时间及住院时间方面优于LATG组,差异均有统计学意义[(36.9±3.0)min比(39.4±4.5)min,(4.2±0.5)d比(5.2±0.6)d、(9.5±1.6)d比(10.8±2.4)d,t=-2.554、-7.135、-2.595,均P<0.05]。RATG组淋巴结清扫数多于LATG组[(29.8±6.2)个比(26.3±7.5)个,t=2.197,P<0.05]。结论达芬奇机器人在全胃切除术中应用后离断式手工缝合进行消化道重建是安全可行的。Objective To evaluate the safety and feasibility of robot assisted total gastrectomy plus hand-sewn esophagojejunostomy.Methods The clinical data of 72 patients diagnosed with gastric cancer and undergoing total gastrectomy at the First Affiliated Hospital of Ningbo University from Nov 2021 to May 2024 were retrospectively analyzed.They were divided into two groups:robot-assisted total gastrectomy(RATG)group,consisting of 30 patients,and laparoscopic assisted total gastrectomy(LATG)group,consisting of 42 patients.In the RATG group,the digestive tract was reconstructed by manual suture under the robot scope and Roux-Y reconstruction was performed.In LATG group,digestive tract reconstruction was performed using an in vitro stapler and Roux-Y.The clinicopathological data,perioperative indexes,and postoperative follow-up data of both groups were observed and analyzed.Results All 72 patients successfully completed the operation without conversion to open laparotomy.The total operation time in RATG group was longer than that in LATG group[(235.2±25.8)min vs.(200.7±40.6)min,t=4.099,P<0.05)].RATG was superior to LATG group in terms of digestive tract reconstruction time,postoperative fluid intake time and hospitalization days,the difference was statistically significant[(36.9±3.0)min vs.(39.4±4.5)min,(4.2±0.5)d vs.(5.2±0.6)d、(9.5±1.6)d vs.(10.8±2.4)d,t=-2.554,-7.135,-2.595,all P<0.05];In terms of postoperative pathology,the number of lymph node dissection in RATG group was higher than that in LATG group[(29.8±6.2)vs.(26.3±7.5),t=2.197,P<0.05].Conclusion The application of delayed disconnection hand-sewn esophagojejunostomy in Da Vinci robot total gastrectomy is safe and feasible for cure-intent total gastrectomy in patients of gastric carcinoma.

关 键 词：胃肿瘤 吻合术 外科 机器人 胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]