探讨机器人肝尾状叶切除的可行性、安全性及其手术技巧。

回顾性分析2009年7月至2012年5月在解放军总医院行机器人肝尾状叶切除的7例患者临床资料。其中男6例，女1例；年龄36～65岁，中位年龄51岁；肝门部胆管癌5例，尾状叶肝细胞癌合并肝门部胆管癌栓1例，肝内胆管细胞癌1例。患者均签署知情同意书，符合医学伦理学规定。腹壁建立6个Trocar，植入达芬奇机器人手术系统，行肝尾状叶切除，整个手术过程不需要Pringle法阻断入肝血流。

除1例以Hybrid完成手术，其余6例均以全机器人方式成功完成手术，无中转开腹。其中联合右半肝切除4例，联合左半肝切除2例，联合肝右三叶切除1例。手术时间中位数为694（600～720）min，失血量为1 360（400～3 000）ml，5例术中输血。1例术后18 d死于肝衰竭。4例术后出现并发症，其中2例胆漏，1例胆漏合并下肢深静脉血栓，均保守治愈；1例术后2 d因肝动脉瘤破裂出血经开腹动脉瘤切除重建治愈。术后住院时间为15（9～19）d。

机器人肝尾状叶切除是安全、可行的，其拓展了腹腔镜肝切除的适应证，有利于精准的肝门部解剖和腹腔镜下缝合，尤其适合肝门部胆管癌肝尾状叶切除。

To investigate the feasibility, safety and surgical techniques of robot-assisted caudate lobectomy.

Clinical data of 7 patients who underwent robot-assisted caudate lobectomy in the PLA General Hospital between July 2009 and May 2012 were retrospectively analyzed. Among them, 6 cases were males and 1 female, aged 36-65 years old with a median age of 51 years old. Five cases were diagnosed with hilar cholangiocarcinoma, 1 with hepatocellular carcinoma in caudate lobe complicated with hilar cholangiocarcinoma thrombus, and 1 with intrahepatic cholangiocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Six Trocars were created at the abdominal wall and the da Vinci surgical system (DVSS) was implanted. The caudate lobectomy was performed without occlusion of hepatic blood inflow by Pringle method.

Except 1 patient underwent surgery with Hybrid, the other 6 patients successfully underwent surgery only with DVSS. No conversion to laparotomy was observed. Among the surgery, 4 cases were combined with right lobe resection, 2 cases with left lobe resection and 1 case with extented right hepatectomy. The median operation time was 694(600-720) min. The blood loss was 1 360(400-3 000) ml. Five cases received blood transfusion during surgery. One case died of liver failure 18 d after surgery. Postoperative complications were observed in 4 patients. Among them, 2 cases of bile leakage and 1 of bile leekage complicated with deep venous thrombosis in the lower extremity were all cured after conservative therapy, and 1 case of hemorrhage caused by ruptured hepatic artery aneurysm 2 d after surgery was cured by open resection and reconstruction of aneurysm. The postoperative length of hospital stay was 15(9-19) d.

Robot-assisted caudate lobectomy is safe and feasible, which broadens the indications of laparoscopic hepatactomy and is beneficial to precise hilar dissection and laparoscopic suture, especially for caudate lobectomy of hilar cholangiocarcinoma.