机器人辅助胰腺手术:附33例报告

Robotic-assisted Pancreatic Surgery:Report of 33 Cases

目的探讨机器人外科手术系统辅助胰腺手术的安全性、可行性。方法 2010年3月～2011年9月完成机器人辅助胰腺手术33例,其中胰十二指肠切除术11例,胰体尾切除术10例(其中5例保留脾脏),胰腺中段切除术7例,Beger术4例,胰腺肿瘤切除术1例。结果 33例均在机器人辅助手术系统下完成手术,无中转开腹。11例胰十二指肠切除术手术时间(457.7±39.1)min,术中出血(667.3±271.6)ml,6例术中输血;7例胰腺中段切除术手术时间(215.7±55.9)min,术中出血(192.9±109.7)ml,无术中输血;10例胰体尾切除术手术时间(159.0±81.0)min,术中出血量中位数500 ml(50～1200 ml),2例术中输血;4例Beger术手术时间(298.8±33.8)min,术中出血(425.0±236.3)ml,无术中输血;1例胰腺肿瘤切除术手术时间190 min,术中出血50 ml,无术中输血。33例术后住院(21.6±8.0)d。术后胰漏14例,吻合口出血3例,吻合口漏1例,除1例术后吻合口漏、1例吻合口出血者行二次手术治疗外,其余患者经保守治疗后顺利康复。术后病理:8例为恶性肿瘤,且切缘全部阴性;22例为良性肿瘤;3例为慢性胰腺炎。33例随访1～19个月,(13.5±5.7)月,1例导管腺癌术后6个月肿瘤复发,进行化疗,余7例恶性肿瘤未发现肿瘤复发转移,其余患者均恢复良好,随访至2012年1月无病人死亡。结论机器人辅助手术系统应用于胰腺外科是安全、可行的。

Objective To explore the safety and feasbility of robot-assisted pancreatic surgery. Methods Since March 2010 to November 2011, with a robotic-assited system, we perforated pancraeatic surgery on 33 patients, including 11 cases of panereaticoduodenectomy, 10 distal pancreatectomy （the spleen was preserved in 5 of the cases）, 7 medial panereateetomy, 4 Beger＇ s procedure, and 1 resection of pancreatic carcinoma. Results The procdures were all completed with the robotic-assited system without conversion to open surgery. The operation time for pancreaticoduodenectomy, medial pancreatectomy, distal panereateetomy, Beget＇ s procedure, and resection of pancreatic carcinoma was （457.7 ± 39. 1 ） , （215.7 ± 55.9） , （ 159.0 ± 81.0） , （298.8 ± 33.8 ）, and 190 min, respectively. And the intraoperative blood loss of the procedures was （667.3 ± 271.6） , （192.9 ± 109.7）, 500 （medium, ranged from 50 to 1200 ml）, （425.0 ± 236.3） , and 50 ml; totally 8 patients received blood transfusion, 2 of them were from the Beger＇s procedure group, and the other 6 underwent pancreaticoduodenectomy. The postoperative hospital stay of the 33 patients was （21.6 ± 8.0） d. After the procedures, 14 patients developed pancreatic leak, 3 showed anastomotic hemorrhage, 1 had anastomotic leakage, all of the complications were cured by conservative therapies except for one case of anastomotie hemorrhage, which was cured by a second operation. Postoperative pathological examination showed malignant tumor with negative margin in 8 patients, benign tumors in 22 （ including 3 cases of chronic pancreatitis）. Follow-up was achieved in all the patients for 1 to 19 months with a mean of （13.5 ± 5.7） months, recurrent ductal adenocarcinoma occurred in 1 patient, who thus received chemotherapy; no metastasis or recurrence was found in the other 7 patients who had malignancy. The rest of the patients recovered well, and no patients died by the end of the follow-up in January 2012. Conclusion Robotic-assisted system is safe and applicable for pancreatic surgery.