微创胰体尾切除术——机器人手术系统的优势

Robot-assisted distal pancreatectomy

目的探讨机器人手术方式在胰体尾切除术上的可行性、安全性、适应证以及与腹腔镜相比优劣势。方法回顾性分析自2005年9月到2012年4月完成的微创胰体尾切除术51例，根据手术方式分为机器人手术组（RDP组，n=21）与腹腔镜手术（LDP组，n=30），比较两组术中情况（包括手术时间、术中出血量、输血量等）与术后恢复情况（包括术后住院天数、并发症发生率、保脾率等），并进行对比分析。结果RDP组中转开腹1例，中转率4．76％（1／21）。与LDP组相比，RDP组良性肿瘤保脾率较高（61．5％比25．0％，χ2=4．786，P=0．039），淋巴结清扫程度也较LDP组彻底（4．14±2．73枚比1．33±1．21枚，t=2．203，P=0．041）。结论胰体尾肿瘤采用机器人胰体尾切除术是安全可行的。对于保脾胰体尾切除术及标准胰体尾癌根治术，机器人手术系统是有其优势的。

Objective To evaluate the feasibility, safety and the indications of robotic distal pancreateetomy, and to discuss the advantages and disadvantages as compared to respective laparoscopic procedures. Methods Between September 2005 and April 2012, 21 patients underwent robot-assisted laparoscopic distal pancreatectomies （RDP group, n = 21 ） and 30 patients underwent the traditional laparoseopics （ LDP group, n = 30） at our center. Data for operation time, blood loss and complications were collected and statistically analyzed. Results There was one conversion to open surgery in RDP group and the conversion rate was 4. 76% （ 1/21 ）. Compared with LDP, RDP group had a significantly higher spleen- preserving rate for benign tumors （61.5% vs. 25.0% ,χ2 =4. 786,P =0. 039）, and more retrieved lymph nodes （4. 14 ± 2. 73 vs. 1.33 ± 1.21, t = 2. 203, P = 0. 041 ）. Conclusions Robot-assisted distal pancreatectomy is a feasible, less-invasive option for tumors in the pancreas tail, hence is superior in many respects to laparoscopic procedures.