“达芬奇”机器人在肝胆胰手术中的应用(单中心报道)

Application of da Vinci surgical system in hepatobiliary and pancreatic surgery: a single center experience

目的:总结"达芬奇"机器人手术系统在我中心进行肝胆胰手术的临床经验。方法 :回顾性分析我科2010年3月至2013年3月间机器人肝胆胰手术124例临床资料和手术并发症的发生率。结果:肝脏手术组15例,中转开腹1例,中转腹腔镜手术1例,该组所有病人围手术期无并发症,无死亡病例。手术时间(199.6±110.5)min,术中出血(703.3±1 260.7)mL,术后住院(11.0±3.6)d。胆囊手术组7例,无中转开腹病人,并发症发生率14.3%,无死亡病例。手术时间(212.9±64.2)min,术中出血(257.1±127.2)mL,术后住院(6.8±2.5)d。胰腺手术组102例,其中良性病人中1例中转开腹,并发症发生率50.0%,无死亡病例;恶性病人中2例中转开腹,并发症发生率55.9%,1例死亡。胰十二指肠切除术31例,手术时间(450.4±102.1)min,术中出血(506.5±266.5)mL,术后住院(34.4±7.8)d;胰体尾切除术42例,手术时间(161.0±68.7)min,术中出血(278.0±331.5)mL,术后住院(20.9±10.9)d;胰腺中段切除术16例,手术时间(215.6±45.7)min,术中出血(145.6±118.4)mL,术后住院(22.7±8.0)d;Beger术7例,手术时间(284.2±35.8)min,术中出血(321.7±244.2)mL,术后住院(26.3±7.7)d;局部切除术6例,手术时间(116.7±37.2)min,术中出血(61.7±69.1)mL,术后住院(27.8±11.8)d。结论:"达芬奇"机器人系统可独立完成各类肝胆胰手术,安全可行,推动了微创外科领域的发展进程,尤其在复杂的肝胆胰手术方面,有效地补充传统的腹腔镜手术。但在机器人手术开展初期,应慎重选择胰腺手术病人。

Objective To summarize the clinical experience of robotic hepatobiliary and pancreatic surgery in our center. Methods da Vinci surgical system was applied to perform robotic hepatobiliary and pancreatic operations for 124 patients from Mar 2010 to Mar 2013. The intra-and post-operative data including morbidity were analyzed. Results The robotic hepatectomy was performed in 15 cases. One case was converted to open surgery and 1 case laparoscopic surgery. There was no morbidity and no mortality in these cases. The mean operation time, operative bleeding and postoperative stay were （199.6±110.5） min, （703.3±260.7） mL and （11.0±.6） days, respectively. Robotic biliary operations were performed in 7 cases, none was converted to open surgery, the morbidity was 14.3% and no mortality. The results of the 3 operative and postoperative parameters were （212.9±64.2） min, （257.1±27.2） mL and （6.8±.5） days, respetively. For 102 cases of the roboic pancreatic surgery, 1 case in the benign subset was converted to open surgery and the morbidity 50.0% and no mortality. Two cases in the malignant subset were converted to open suregery, the morbidity is 55.9% and 1 patient was dead during the perioperative period. The pancreatic operations involves in 5 types. The number of cases in each operative type and the results of the 3 operative and postoperative parameters were as follows： 31 cases with pancreaticoduodenectomy and the parameters were （450.4±02.1） min, （506.5±66.5） mL, （34.4±.8） days; 42 cases with distal pancreatectomy and （161.0±8.7） min, （278.0±31.5） mL, （20.9±0.9） days; 16 cases with medial pancreatectomy and （215.6±5.7） min, （145.6±118.4） mL, （22.7±.0） days; 7 cases with Beger operation and （284.2±35.8） rain, （321.7±44.2） mL, （26.3±.7） days; and 6 cases with enucleation and （116.7±7.2） min, （61.7±9.1） mL, （27.8±11.8） days, respectively. Conclusions With da Vinci surgical system, the surgeon can safely and feasibly perform all kinds of hepatobiliary and pancreatic operations promoting the development of minimally invasive surgery. The application of da Vinci surgical system is the effective supplement to traditional laparoscopic surgery especially in complicated hepatobiliary and pancreatic surgery. At the first period of the application of robotic surgery, the patients should be carefully chosen especially for cases with pancreatic operations.