腹腔镜和机器人技术在肝胆管结石病治疗中的应用及评价

Application and evaluation of laparoscopic and robotic-assisted laparoscopic surgery in the treatment of hepatolithiasis

肝胆管结石病在我国部分地区的发病率仍较高,传统开放手术作为其经典治疗方式存在创伤大、恢复慢等问题。近年来,腹腔镜的技术进步和器械更新、尤其是da Vinci手术机器人引入临床,为肝胆管结石病的治疗提供了一条崭新途径。目前,腹腔镜手术已广泛应用于肝胆管结石病的治疗,且已证实能达到与开放手术同样的疗效,包括结石清除率,残留、复发率以及远期疗效优良率等,并具有创伤小、术后恢复快、切口美容等近期疗效优势,其适应证为早期、区域型肝胆管结石病。da Vinci手术机器人解决了传统腹腔镜技术在视野、器械操作灵活性等方面的局限性,突破了腹腔镜外科发展受限的瓶颈,使得复杂肝胆管结石病的微创治疗成为可能。从早期临床实践来看,手术机器人系统应用于选择性复杂肝胆管结石病安全、可行,特别适用于合并肝门区胆管病变,需要行肝门部胆管整形及重建的复杂肝胆管结石病。但目前手术机器人治疗复杂肝胆管结石病的报道极少,其在肝胆管结石病治疗中应用的适应证、技术方法和疗效等尚需大样本研究以及长时间随访结果进一步评估总结。

The incidence of hepatolithiasis is high in some areas of China. As its classic treatment method, traditional open surgery exists more trauma, slow recovery and other issues. In recent years, advances in laparoscopic techniques and equipment updates, especially the introduction of da Vinci surgical robot in clinical practice has provided a new way for the treatment of hepatolithiasis. Currently, laparoscopic surgery has been widely used in the treatment of intrahepatic bile duct stones, and has been proven to achieve the same therapeutic effect with open surgery, including stone clearance, residual and recurrence rate with short-term efficacy advantage of less trauma, fast postoperative recovery and cosmetic incision. The indication of laparoscopic surgery is mainly for early regional type hepatolithiasis, da Vinci surgical robot can overcome the limitations of conventional laparoscopic surgery in terms of vision and instrumentation flexibility, making the minimally invasive treatment of complex hepatolithiasis possible. Based on the limited clinical experience, surgical robot system is safe and feasible in the treatment of selectively complex hepatolithiasis, especially for those with hilar bile duct stricture which need plasty and reconstruction. Because of the reported cases of complicated hepatolithiasis treated by using surgical robot procedure are few, it still need large sample and long-term follow-up to study indications, efficacy and technical methods of the minimally invasive approach in the treatment of intrahepatic bile duct stones.