机器人辅助前正中入路肝尾状叶肿瘤切除

Robotic liver resection for caudate lobe tumor through middle anterior approach

目的:探讨机器人辅助前正中入路肝尾状叶肿瘤切除的手术技术及临床应用,提出微创肝脏手术的新入路。方法:分析2012年11月我院于机器人手术系统(da Vinci S)辅助下完成的1例前正中入路肝尾状叶肿瘤切除术,术前CT血管造影图像建立肝脏3D模型,确定经肝正中裂前入路行尾状叶肿瘤切除的手术方案。结果:病人男性,78岁。完全机器人辅助顺利完成手术。完整切除肿瘤。手术时间360 min,术中出血300 mL,无术中、术后输血。术后病理为肝细胞癌。未发生术后并发症,术后28天出院,随访至今1年余,恢复良好。结论:肝正中裂前入路可提高肝尾状叶肿瘤的手术切除率,保留更多的正常肝组织。在精确的术前评估后,机器人手术系统下肝尾状叶肿瘤切除术安全、可行。

Objective To investigate the surgical technique and clinical application of new method of minimally in- vasive liver surgery with robotic liver resection for caudate lobe tumor through middle anterior approach. Methods A pa- tient with liver caudate lobe tumor resection through middle anterior approach by robot surgical system （da Vinci S） in November 2012 was analyzed. The computer 3D model of liver was built based on preoperational CTA imaging and the middle anterior approach for caudate lobe tumor resection was set up. Results Patient was male with 78 years old. The operation was performed completely with robot surgical system. Operating time was 360 min and estimated blood loss 300 mL. There was no intraoperative and postoperative transfusion. No postoperative complication was found. Hepatic cel- lular carcinoma was diagnosed by pathology. The patient was discharged 28 days post-operationally. The follow-up was done more than 1 year with a good health till now. Conclusions The middle anterior approach could be performed for in- creasing the resection rate of liver tumor in the caudate lobe and preserving much tissue of normal liver. By accurate eva- luation preoperatively in detail, robotic liver resection for caudate lobe tumor can be done safe and feasible.