机器人辅助腹腔镜下袖状胃切除手术的应用体会

Application of robot assisted laparoscopic sleeve gastrectomy

目的探讨达芬奇机器人系统辅助腹腔镜下袖状胃切除术的安全性及临床效果。方法回顾性分析2021年4至9月在新疆维吾尔自治区人民医院微创,疝和腹壁外科接受第四代达芬奇机器人辅助下腹腔镜袖状胃切除术及袖状胃+手术40例患者的临床资料。结果40例患者均顺利完成机器人辅助下腹腔镜袖状胃切除手术,无中转开腹,其中单纯袖状胃切除术(LSG)21例,联合保留部分胃底折叠(Dor)+食管裂孔疝修补术10例;联合保留部分胃底折叠(Dor)+食管裂孔疝修补术+his角重建1例;联合胃底折叠(Nisson)+食管裂孔疝修补术1例;联合his角重建5例;联合胆囊切除术2例。发生术后并发症1例(6.67%),即术后48 h内出现腹腔及腹壁出血,经保守治疗后痊愈。术后平均住院时间5 d,平均手术时间2.5 h。结论与传统手术相比,达芬奇机器人辅助下腹腔镜袖状胃切除术具有解剖更精细、操作灵活及术中视野更清楚的优点,是一种安全、有效的微创手术。

ObjectivesTo investigate the safety and clinical effect of Da Vinci robot system-assisted laparoscopic sleeve gastrectomy.MethodsA retrospective analysis of the clinical data of 40 patients who underwent the fourth-generation Da Vinci robot-assisted laparoscopic sleeve gastrectomy and sleeve gastric surgery in the Minimally Invasive,Hernia and Abdominal Surgery Department of the People's Hospital of Xinjiang Uygur Autonomous Region from April to September 2021.ResultsAll the 40 patients successfully completed robot-assisted laparoscopic sleeve gastrectomy without conversion to laparotomy,including simple sleeve gastrectomy(LSG)in 21 cases,combined with partial gastric fundus folding(Dor)and esophageal hiatal herniorrhaphy in 10 cases.Combined fundus preservation(Dor)and esophageal hiatus hernia repair and"His angle"reconstruction in 1 case.Combined gastric fundus folding(Nisson)and esophageal hiatus hernia repair in 1 case.Combined"His angle"reconstruction in 5 cases.Combined cholecystectomy in 2 cases.Postoperative complications occurred in 1 case(6.67%),that is,abdominal hemorrhage and abdominal wall hemorrhage occurred within 48 hours after surgery,which was cured after conservative treatment.The average postoperative hospital stay was 5 days,and the average operation time was 2.5 hours.ConclusionsCompared with traditional surgery,the Da Vinci robot-assisted laparoscopic sleeve gastrectomy is a safer and more effective minimally invasive surgery which has the advantages of finer anatomy,flexible operation and clearer intraoperative vision.