机器人手术系统在早期卵巢恶性肿瘤手术中的临床应用

Robotic surgery in the management of early ovarian malignancy tumors

目的：探讨早期（Ⅰ期）卵巢恶性肿瘤应用机器人手术系统治疗的可行性。方法自2012年4月至2013年9月，解放军总医院采用da Vinci机器人手术系统，完成7例早期卵巢恶性肿瘤患者的手术治疗，患者平均年龄为45.7岁。手术范围包括子宫全切除、附件切除、腹主动脉旁和盆腔淋巴结切除、大网膜切除、阑尾切除。观察患者的围手术期相关指标和随访结果。结果7例早期卵巢恶性肿瘤患者均采用da Vinci机器人手术系统顺利完成再分期手术，无一例中转开腹。手术时间为100～330 min，平均225 min；术中出血量为20～600 ml，平均171 ml；盆腔淋巴结切除11～34枚，平均18.3枚；腹主动脉旁淋巴结切除3～4枚，平均3.7枚，所有切除的淋巴结送病理检查均未发现肿瘤转移。7例患者术中均未予输血，且均无术中和术后并发症发生。术后平均随访时间为26.0个月（20～36个月），随访期内患者均无肿瘤复发征象，均无瘤生存。结论机器人手术系统可以应用于早期卵巢恶性肿瘤的手术治疗，为临床上提供了1种新的微创技术的选择。

Objective To apply robotic surgery of early ovarian malignancy tumors clinically and evaluate its feasibility in management for early ovarian cancer. Methods Using the da Vinci robotic surgical system, seven patients with early ovarian malignancy tumors （stage Ⅰ） underwent robotic surgery from April 2012 to September 2013. The average age was 45.7 years. Robotic surgeries approaches contained salpingo-oophorectomy,para-aortic lymphadenectomy, pelvic lymphadenectomy, omentectomy and appendectomy. Perioperative and follow-up clinical data were recorded. Results All robotic surgeries were successfully completed without the conversion to laparotomy. The mean operative time was 225 minutes （100-330 minutes）. The average estimated blood loss was 171 ml （20-600 ml）. No patients received blood transfusions. No intraoperative and postoperative complications were observed. The average number of pelvic lymph node dissected were 18.3 （11-34）. The average number of para-aortic lymph node dissected were 3.7 （3-4）. The mean follow-up time was 26.0 months after surgery （20-36 months）. Currently, all patients had no tumor recurrence and survived. Conclusion Robotic surgery is feasible as a novel alternative approach in the treatment of early ovarian malignancy tumors.