探讨达芬奇机器人辅助肝切除术的安全性及临床应用价值。

回顾性分析2015年4月至2018年12月在中山大学附属第一医院接受达芬奇机器人辅助肝切除术的71例患者临床资料。患者均签署知情同意书，符合医学伦理学要求。其中男48例，女23例；年龄18～76岁，中位年龄56岁。肝脏恶性肿瘤54例，肝脏良性肿物4例，肝门部胆管癌1例，肝囊肿1例，肝内胆管结石10例，先天性胆管囊性扩张症Ⅴ型1例。分析其临床转归。

90%（64/71）患者顺利完成机器人辅助肝切除术，中转开腹率10%（7/71）。其中行左半肝切除术15例，左半肝联合尾状叶切除2例，右半肝切除术7例，肝中叶切除1例，2个及以上肝段切除术28例，1个肝段或肿瘤局部切除术18例。机器人手术中位时间为285（196，374）min，术中出血量为100（50，300）ml。术后病理检查示R0切除率100%。术后并发症发生率11%（8/71），其中腹腔感染4例，泌尿系感染1例，深静脉血栓1例，肝功能不全1例，脑梗塞1例，均经保守治疗后治愈。无围手术期死亡。术后住院时间8（7，11）d。

与传统手术相比，机器人辅助肝切除术具有解剖更精细、操作更灵活的优势，是一种安全、可行的微创手术。

To explore the safety and application value of da Vinci robot-assisted hepatectomy in clinical practice.

Clinical data of 71 patients undergoing da Vinci robot-assisted hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from April 2015 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 48 patients were male and 23 female, aged 18-76 years with a median age of 56 years. 54 cases were diagnosed with malignant liver tumors, 4 cases of benign liver tumors, 1 case of hilar cholangiocarcinoma, 1 case of liver cyst, 10 cases of hepatolithiasis and 1 case of type Ⅴ congenital choledochal cyst. The clinical outcomes of patients were analyzed.

Robot-assisted hepatectomy was successfully performed in 90% (64/71) of the patients. The conversion rate to open surgery was 10% (7/71). Among them, 15 cases underwent left hemihepatectomy, 2 cases of left hemihepatectomy combined with caudate lobectomy, 7 cases of right hemihepatectomy, 1 case of mesohepatectomy. 28 cases received resection of 2 or more segments. 18 cases received local resection of tumor or resection of 1 segment. The median time of robot-assisted surgery was 285(196, 374) min, and the intraoperative blood loss was 100(50, 300) ml. Postoperative pathological examination revealed that the R0 resection rate was 100%. The incidence of postoperative complications was 11%(8/71), including 4 cases of abdominal infection, 1 case of urinary infection, 1 case of deep venous thrombosis, 1 case of hepatic insufficiency and 1 case of cerebral infarction. All of them were cured after conservative treatments. No perioperative death occurred. The length of postoperative hospital stay was 8(7-11) d.

Compared with the traditional surgery, robot-assisted hepatectomy has the advantages of more accurate anatomical dissection and more flexible operations, which is a safe and feasible minimally invasive surgery.