探讨陈氏绕肝悬吊技术在机器人辅助腹腔镜右半肝切除术中的应用价值。

回顾性分析2018年6月至2018年12月在华中科技大学同济医学院附属同济医院行腹腔镜右半肝切除术的17例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男13例，女4例；年龄19~74岁，中位年龄55岁；机器人辅助腹腔镜右半肝切除术中应用陈氏绕肝悬吊技术5例（机器人悬吊组），机器人辅助腹腔镜右半肝切除术未应用陈氏绕肝悬吊技术4例（机器人无悬吊组），传统腹腔镜右半肝切除术并应用陈氏绕肝悬吊技术8例（腹腔镜悬吊组）。观察3组患者围手术期情况。3组建立绕肝悬吊时间、断肝时间、术中出血量、术后住院时间比较采用秩和检验；绕肝悬吊成功率比较采用Fisher确切概率法。

机器人悬吊组均成功建立绕肝悬吊，成功率5/5，建立绕肝悬吊中位时间6（6）min；腹腔镜悬吊组成功建立绕肝悬吊6例，成功率6/8，建立绕肝悬吊中位时间12（11）min；使用机器人建立绕肝悬吊时间更短（Z=-2.487，P=0.013），成功率比较差异无统计学意义（P=0.053）。两种手术建立绕肝悬吊过程中均未发生周围组织或血管意外损伤而引起大出血。机器人悬吊组、机器人无悬吊组、腹腔镜悬吊组断肝时间分别为65（80）、75（80）、50（50）min，术中出血量分别为225（450）、300（500）、225（340）ml，术后住院时间分别为8（12）、10（5）、13（12）d，3组比较差异均无统计学意义（H=2.784，0.538，1.857；P>0.05）。3组术后均未发生并发症，无术后30 d内死亡。

机器人辅助腹腔镜右半肝切除术中应用陈氏绕肝悬吊技术是安全、可行的。与传统腹腔镜肝切除相比，机器人辅助下腹腔镜肝切除应用陈氏绕肝悬吊技术更加方便、快捷。

To evaluate the application value of Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy.

Clinical data of 17 patients who underwent laparoscopic right hepatectomy in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2018 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 13 patients were male and 4 female, aged from 19 to 74 years, with a median age of 55 years. In the robot-hanging group, Chen's liver-hanging maneuver was applied in robot-assisted laparoscopic right hepatectomy (n=5), whereas in the robot-no-hanging group, Chen's liver-hanging maneuver was not delivered during robot-assisted laparoscopic right hepatectomy (n=4). In the laparoscopy-hanging group, traditional laparoscopic right hepatectomy combined with Chen's liver-hanging maneuver was adopted (n=8). Perioperative conditions of patients were observed in 3 groups. The liver-hanging time, the time of liver dissection, intraoperative blood loss and the length of postoperative hospital stay among 3 groups were compared by rank sum test. The success rate of liver-hanging maneuver was compared by Fisher's exact test.

In the robot-hanging group, liver-hanging maneuver was successfully performed with a success rate of 5/5, and the median time of liver-hanging maneuver was 6(6) min. In the laparoscopy-hanging group, liver-hanging maneuver was successfully conducted in 6 cases with a success rate of 6/8, and the median time of liver-hanging maneuver was 12(11) min. The median time of liver-hanging maneuver in the robot-hanging group was significantly shorter than that in the laparoscopy-hanging group (Z=-2.487, P=0.013), and no significant difference was observed in the success rate between2 groups (P=0.053). No accidental injury to surrounding tissues or blood vessels, or massive bleeding occurred during two surgical procedures. In the robot-hanging, robot-no-hanging and laparoscope-hanging groups, the time of liver dissection was 65(80), 75(80) and 50(50) min, the intraoperative blood loss were 225(450), 300(500) and 225(340) ml, and the length of postoperative hospital stay were 8(12), 10(5) and 13(12) d, respectively. No significant differences were noted among 3 groups (H=2.784, 0.538, 1.857; P>0.05). No postoperative complications or death occurred with postoperative30 d in 3 groups.

It is safe and feasible to apply Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy. Compared with traditional laparoscopic hepatectomy, robot-assisted laparoscopic hepatectomy combined with Chen's liver-hanging maneuver is more convenient and faster.