机器人手术系统行胰腺癌根治术的疗效分析

Efficacy of robotic surgical system for radical resection of pancreatic carcinoma

目的：探讨机器人手术系统行胰腺癌根治术的有效性、安全性及临床疗效。方法：回顾性分析我院外科自2010年4月至2013年8月收治并实施达芬奇机器人胰腺癌根治术的26例胰腺导管腺癌病人的临床资料。结果：26例病人中3例因肿瘤侵犯血管及周围脏器或术中分离困难．中转开腹手术。10例胰头癌根治术平均手术时间为（469．3±148．2）min，平均术中出血量为（594．00132±304．5）mL；15例胰体尾癌根治术平均手术时间为（182．0±66．3）min，平均术中出血量为（343．3±376．8）mL；1例胰腺中段切除术手术时间为240min，术中出血150mL。全组26例清扫淋巴结（4．0±2．1）枚，术后胃肠功能恢复时间为（3．3±1．3）d，术后住院（24．1±12．0）d。10例出现术后并发症，其中胰漏5例，胆漏2例，吻合口出血1例，胰漏合并门静脉血栓形成1例，吻合口出血合并急性肾功能衰竭1例。除1例因术后出血、急性肾衰死亡，1例行栓塞治疗外，其余病人均经保守治疗后痊愈。25例随访时间为（10．8±5．6）（1-40）个月，术后肿瘤复发转移死亡10例，肿瘤局部复发1例。结论：机器人手术系统行胰腺癌根治术安全、可行，手术创伤小、术后恢复快．扩大了机器人手术在胰腺肿瘤治疗上的适用范围．

Objective To investigate the availability, safety, efficacy of radical resection of pancreatic carcinoma by robotic surgical system. Methods From April 2010 to August 2013, 26 patients with pancreatic ductal adenocarcinoma underwent robotic radical resection of pancreatic carcinoma in our department. The clinical data was analyzed retrospectively. Results Three of the 26 patients were converted to laparotomy because of vascular invasion and involvement of the surrounding organs or difficult dissection. Ten patients underwent radical resection of carcinoma of pancreatic head. The mean operative time was （469.3_＋148.2） min and the blood loss was （594.0±304.5） mL. Fifteen patients underwent radical resection of carcinoma of pancreatic body and tail. The mean operation time was （182.0±66.3 ） min and the blood loss was（343.3±376.8） mL. One patient underwent central pancreatectomy. The operation time was 240 min and the blood loss 150 mL The mean number of lymph node resection was （4.0±2.1） in 26 patients. The mean recovery time of gastrointestinal function was（3.3±1.3） d and postoperative hospital stay time was（24.1±12.0） d. There were 10 cases of postoperative complications, in which 5 cases were pancreatic leakage, 2 cases biliary leakage, 1 case anastomotic hemorrhage, 1 case pancreatic leakage combined with portal thrombosis, 1 case anastomotic hemorrhage combined with acute renal failure. All were cured by conservative treatment, except 1 case death because of postoperative hemorrhage and acute renal failure, 1 case underwent embolotherapy. The follow-up time was （10.8±5.6）（1-40） months. Ten patients died because of tumor recurrence and metastasis, and 1 patient local recurrence. Conclusions Radical resection of pancreatic carcinoma by robotic surgical system is safe and feasible with the advantages of minimally invasive and quick recovery. It expands the applications of robotic surgery of pancreatic tumors.