机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤

doi:10.3877/cma.j.issn.2095-3232.2014.06.004

中华肝脏外科手术学电子杂志 ›› 2014, Vol. 03 ›› Issue (06) : 345 -349. doi: 10.3877/cma.j.issn.2095-3232.2014.06.004

所属专题：机器人手术；文献；

临床研究

机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤

施昱晟¹, 詹茜¹, 邓侠兴¹, 金佳斌¹, 吴志翀¹, 陈皓¹, 沈柏用¹, 彭承宏¹^,^†(

), 李宏为¹

^1. 200025　上海交通大学医学院附属瑞金医院普外科　上海交通大学医学院胰腺疾病研究所

收稿日期:2014-08-15 出版日期:2014-12-10
通信作者: 彭承宏
基金资助:
卫生部卫生行业科研专项(201002020); 上海市科委科研计划项目(11JC1407800)

Pancreaticoduodenectomy with assistance of robotic operation system for pancreatic head cancer

Yusheng Shi¹, Qian Zhan¹, Xiaxing Deng¹, Jiabin Jin¹, Zhichong Wu¹, Hao Chen¹, Baiyong Shen¹, Chenghong Peng¹^,^†(), Hongwei Li¹

^1. Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Research Institute of Pancreatic Diseases Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Received:2014-08-15 Published:2014-12-10
Corresponding author: Chenghong Peng
About author:
Corresponding author: Peng Chenghong, Email:chhpeng@yeah.net

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引用本文：

施昱晟, 詹茜, 邓侠兴, 金佳斌, 吴志翀, 陈皓, 沈柏用, 彭承宏, 李宏为. 机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤[J/OL]. 中华肝脏外科手术学电子杂志, 2014, 03(06): 345-349.

Yusheng Shi, Qian Zhan, Xiaxing Deng, Jiabin Jin, Zhichong Wu, Hao Chen, Baiyong Shen, Chenghong Peng, Hongwei Li. Pancreaticoduodenectomy with assistance of robotic operation system for pancreatic head cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2014, 03(06): 345-349.

目的

探讨机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤的临床应用价值。

方法

回顾性分析2010年5月至2014年4月上海瑞金医院应用达芬奇机器人辅助胰头十二指肠切除术治疗的38例胰头部恶性肿瘤患者临床资料。其中男25例，女13例；平均年龄（59±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。采用"五孔法"置入3枚机器人专用套管（Trocar）及1枚镜头Trocar和1枚辅助Trocar，放入机器人臂，机器人辅助下行胰头十二指肠切除术。观察患者围手术期情况，包括手术时间、术中出血量、手术情况、术后并发症和生存情况等。

结果

38例均顺利完成，完全切除（R0）切除率97%（37/38），R1切除率3%（1/38），中位手术时间413（210～520）min，术中出血量320（50～1 100）ml，淋巴结清扫数15 (2～24)个。术后住院时间20 (7～36) d，术后并发症发生率42%（16/38），其中胰瘘8例、胆瘘2例、术后感染6例。术后生存时间25（3～42）个月，无瘤生存时间14（5～28）个月。

结论

采取机器人辅助胰头十二指肠切除术切除胰头部恶性肿瘤安全、可行。

关键词: 胰腺肿瘤, 胰十二指肠切除术, 达芬奇机器人手术系统, 治疗结果, 手术后并发症, 淋巴结切除术

Objective

To investigate the clinical application value of pancreaticoduodenectomy with the assistance of robotic operation system for pancreatic head cancer.

Methods

Clinical data of 38 patients with pancreatic head cancer undergoing pancreaticoduodenectomy using Da Vinci Si robotic system in Shanghai Ruijin Hospital from May 2010 to April 2014 were analyzed retrospectively. There were 25 males and 13 females with the mean age of (59±10) years old. The informed consents of all patients were obtained and the ethical committee approval was received. Three robotic exclusive Trocars, 1 camera Trocar and 1 assistant Trocar were inserted using 5-port approach and the robotic arms were inserted. Pancreaticoduodenectomy was performed under the assistance of robotic system. The perioperative situation including operation time, intraoperative blood loss, operation, postoperative complication and survive were observed.

Results

All the operations of 38 cases were finished successfully with radical (R0) resection rate 97% (37/38), R1 resection rate 3% (1/38) and the median operation time 413(210-520)min, intraoperative blood loss 320(50-1 100)ml, lymphnode clearance number 15(2-24), postoperative hospital stay 20(7-36)d. The incidence of postoperative complication was 42% (16/38) including pancreatic fistula (n=8), biliary fistula (n=2), postoperative infection (n=6). The postoperative survival time was 25(3-42) months and disease-free survival time was 14(5-28) months.

Conclusion

Pancreaticoduodenectomy with the assistance of robotic operation system is safe and feasible for resecting pancreatic head cancer.

Key words: Pancreatic neoplasms, Pancreaticoduodenectomy, Da Vinci Si robotic system, Treatment outcome, Postoperative complications, Lymph node excision

图1 机器人辅助胰头十二指肠切除手术过程

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