机器人手术系统结直肠癌肝转移同期切除术的临床应用

Clinical application of robot-assisted surgical system in the simultaneous radial resection of colorectal liver metastases

目的 探讨机器人手术系统在结直肠癌肝转移同期切除术中的应用价值.方法 采用回顾性横断面调查研究方法.收集2013年5月至2015年6月复旦大学附属中山医院收治31例结直肠癌肝转移患者的临床资料.经多学科团队讨论后,31例患者施行机器人手术系统结直肠癌肝转移同期切除术.其中1例典型病例,男59岁.术前结肠镜活组织病理学检查结果示直肠腺癌,术前MRI检查示肝左外叶转移癌.根据术后病理学检查结果制订相应化疗方案.采用门诊复查方式进行随访,复查项目包括体格检查、血清肿瘤标志物、腹盆腔增强CT、肺部CT、肝脏MRI、盆腔MRI、结肠镜等.随访时间截至2015年12月.结果 所有患者顺利完成手术,无中转开腹或中转腹腔镜手术患者,无围术期严重并发症和死亡患者.该例典型患者行机器人手术系统肝左外叶切除＋肝左内叶部分切除＋直肠癌根治术.其中肝左内叶病灶为术中机器人手术系统超声探头发现,经术后病理学检查证实为直肠癌转移,直径为0.5 cm.手术时间为280 min,其中术者操作机器人手术系统时间为210 min,辅助切口及吻合时间为40 min,机械臂装配时间为30 min.术中出血量约为100 mL.患者术后2d肠道排气,3d进流质食物,6d拔除腹腔引流管,7d出院.术后无并发症发生.术后病理学检查结果示溃疡型直肠腺癌,分化程度为Ⅱ～Ⅲ级,分期为T3N0M1期;检出肠系膜淋巴结18枚,未见癌转移;切除的3个肝转移癌病理学检查符合直肠腺癌肝转移.术后2周行mFOLFOX6方案辅助化疗,每2周重复1次,共计12次.随访期间未见肿瘤复发.结论 机器人手术系统结直肠癌肝转移同期切除术安全、有效、可行,具有手术创伤小、术后恢复快等优势.

Objective To investigate the application value of robot-assisted surgical system in the simultaneous radical resection of colorectal liver metastases （CRLM）.Methods The retrospective cross-sectional study was adopted.Thirty-one patients with CRLM were admitted to the Zhongshan Hospital of Fudan University between May 2013 and June 2015.After the discussion of muhidisciplinary team,robot-assisted simultaneous radical resection of CRLM was performed.Of the 31 patients,a typical 59-year-old male patient was diagnosed as with rectal adenocarcinoma by preoperative colonoscopic biopsy and metastatic cancer at left lateral lobe of liver by preoperative MRI.The chemotherapy regimens were prepared according to the postoperative pathological examination.The follow-up of outpatient reexamination was performed till December 2015,including physical examination,serum tumor markers test,abdominal/pelvic enhanced CT,pulmonary CT,hepatic MRI,pelvic MRI and colonoscopy.Results All the 31 patients underwent successful operations,with no severe perioperative complications and death and without conversion to open surgery or laparoscopic surgery.The typical patient underwent robot-assisted left lateral lobectomy of liver ＋ partial left internal lobectomy of liver ＋ radical resection of rectal cancer.The lesion at the left internal lobe of liver was detected by intraoperative ultrasonic probe of robotassisted surgical system with a diameter of 0.5 cm,and CRLM was confirmed by postoperative pathological examination.The operation time was 280 minutes,including robot-assisted surgery time of 210 mintues,assisted incision anastomosis time of 40 mintues and robotic arm assembly time of 30 minutes.Volume of intraoperative blood loss was 100 mL.The postoperative exsufflation,fluid diet intake,abdominal drainage-tube removal and discharge from hospital occurred at postoperative day 2,3,6 and 7,respectively,wiht no occurrence of complications.The postoperative pathological examination result showed ulcerative rectal adenocarcinoma with the grade Ⅱ-Ⅲ differentiation and T3NOM1 stage,and 18 mesenteric lymph nodes were detected without cancer metastasis.Three resectable lesions of liver metastasis were confirmed as with CRLM by postoperative pathological examination.The typical patient received adjuvant chemotherapy of mFOLFOX6 regimen once every 2 weeks up to 12 times from 2 weeks postoperativly,with no reccurrence of tumor during the follow-up.Conclusion Robotassisted surgical system in the simultaneous radical resection of CRLM is safe,effective and feasible,with an advantage of faster postoperative recovery.