食管癌术中用达芬奇机器人游离胃的临床经验

Clinical experience of gastric mobilization using the da Vinci S surgical system in a patient with esophageal cancer

目的:探讨在食管癌根治术中利用达芬奇(da Vinci)S机器人游离胃的可行性。方法:2009年8月在1例食管癌根治术中应用da Vinci S机器人游离胃。脐孔上缘建立气腹,穿刺Trocar,置入内窥镜成像系统作为观察孔。于左侧腋前线肋缘下2cm、右锁骨中线平脐上2cm、左锁骨中线平脐上2cm及右腋前线肋缘下2cm处穿刺Trocar作为机械臂和辅助操作孔。机器人完全游离胃后拉入胸腔,做胃管,切除食管大部,于奇静脉上方行食管胃侧侧吻合术。结果:机器人胃游离术成功,机器人手术时间270min。术中出血500ml。术后病理为鳞状细胞癌,共清扫淋巴结24枚,TNM分期为T3N0M0。随访3个月,无肿瘤复发、转移。结论:在食管癌根治术中用机器人游离胃安全可行。

Objective：To evaluate the clinical feasibility of the gastric mobilization using the da Vinci S surgical system in a patient with esophageal cancer.Methods：In Aug.2009 gastric mobilization was performed through abdominal Trocar using the da Vinci S surgical system in a patient with esophageal cancer.The pneumoperitoneum was created through the upper umbilicus,Trocar and endoscope was inserted as observation port.Five Trocars were inserted through the upper umbilicus,2cm below the costal arch in the left and right anterior axillary line respectively,below the costal arch at both the midclavicular lines.After full mobilization using da Vinci S surgical system,the stomach was pulled over into the chest cavity through esophageal hiatus,gastric tube conduit was done,esophageal cancer was dissected,side to side esophageal gastric anastomosis was performed in the upper part of the azygos vein.Results：Gastric mobilization using the da Vinci S surgical system was performed successfully,without conversion to open surgery,the da Vinci operation time was 270min,and blood loss was 500ml.Postoperative pathology was squamous cancer.The number of harvested lymph nodes was 24.The TNM staging was T3N0M0.No intra-and post-operative complications occurred.After 3 months follow up,no postoperative death,tumor recurrence or metastasis were found.Conclusions：Gastric mobilization using the da Vinci S surgical system is safe and feasible.