手术机器人在妇科恶性肿瘤手术中的临床应用分析

Clinical application of robotic surgical system in gynecological malignant tumor surgery

目的:分析探讨机器人辅助下妇科恶性肿瘤手术的安全性、可行性及临床价值。方法:回顾性总结吉林省肿瘤医院2014年10月—2020年3月实施的213例达芬奇机器人妇科恶性肿瘤手术病例,其中宫颈癌122例,子宫内膜癌89例,卵巢癌(补充手术)1例,阴道癌1例。分析患者的临床资料、手术情况及治疗效果,并对手术时间、术中失血量、术后肠道功能恢复时间、膀胱功能恢复时间、腹部切口愈合时间、淋巴结切除数目、术后并发症发生情况(出血、感染、尿潴留、肠梗阻、下肢静脉血栓等)、总住院时间、至少1年的随访结果等指标进行评估。结果:213例手术均顺利完成,无中转开腹或更改术式。无术中并发症(如重要血管大出血,膀胱、输尿管、肠道损伤等)发生。术后出现双侧淋巴囊肿4例,单侧淋巴囊肿10例,其中1例淋巴囊肿感染,经超声穿刺、抗感染后好转,其余经对症处置后减轻;单侧下肢肌间静脉血栓1例,经溶栓治疗后好转;尿潴留1例,经膀胱功能锻炼后导尿管顺利拔出;阴道断端愈合差1例,经阴道消毒、上药后愈合良好。术后规范治疗,随访时间为12~52个月,其中1例宫颈高级别神经内分泌癌患者于术后13个月发生肺转移、锁骨上淋巴结转移,于术后25个月死亡;1例阴道癌患者于治疗结束31个月后复发,后放弃治疗失访;1例卵巢癌补充根治术患者于术后17个月复发,后放弃治疗并死亡。结论:达芬奇机器人手术系统应用于妇科恶性肿瘤手术安全、可行,其微创优势明显,患者创伤小、出血少、恢复快,手术安全性高,具有临床应用价值,值得临床推广。

Objective:To analyze the safety,feasibility and clinical value of Da Vinci surgical system in gynecological malignant tumor surgery.Methods:213 cases of Da Vinci robotic surgeries for gynecological malignant tumors in Jilin Cancer Hospital from October 2014 to March 2020 were retrospectively reviewed,including 122 cases of cervical cancer,89 cases of endometrial cancer,1 case of ovarian cancer(supplementary surgery),and 1 case of vaginal cancer.The clinical data,operative condition and clinical efficacy were analyzed,of which the operative time,intraoperative blood loss,recovery time of bowel function after surgery,recovery time of bladder function after surgery,abdominal incision healing time,the number of lymph node dissection,postoperative complications(bleeding,infection,urinary retention,intestinal obstruction,thrombus of lower extremity veins,etc.),the total length of hospital stay,and at least 1 year of follow-up results were analyzed.Results:All the 213 surgeries were successfully completed without conversion to laparotomy.No intraoperative complications such as excessive bleeding of blood vessels,injury of bladder,ureter or bowel occurred.4 cases of bilateral lymphocyst and 10 cases of unilateral lymphocyst were found after surgery.1 case of lymphocyst infection occurred and improved after ultrasound-guided puncture and anti-inflammatory treatment,the rest of lymphocyst were relieved after symptomatic treatment.1 case of unilateral lower limb intermuscular vein thrombosis was improved after thrombolytic therapy.The urinary catheter was removed successfully after bladder functional training in a patient with urinary retention.The broken end of vagina healed poorly in 1 case,and healed well after vaginal disinfection and taking medicine.The follow-up time was 12 to 52 months.One patient with high grade neuroendocrine cervical carcinoma had lung metastasis and supraclavicular lymph node metastasis 13 months after surgery,and died 25 months after surgery.1 patient with vaginal cancer recurred 31 months after surgery,and then abandoned treatment and lost to follow-up.1 patient with ovarian cancer recurred 17 months after the surgery and died after giving up treatment.Conclusion:Da Vinci surgical system is safe and feasible for gynecological malignant tumor surgery.With obvious minimally invasive advantages such as less bleeding,less trauma,quick recovery and high safety,it is of high clinical application value and worthy of clinical promotion.