达芬奇机器人胃癌及结直肠癌手术647例临床研究

Application of da Vinci robotic surgical system in radical resection of gastric and colorectal cancer ：a report of 647 cases

目的 探讨达芬奇机器人手术系统胃癌及结直肠癌根治术的安全性及可行性.方法 回顾性分析第三军医大学西南医院全军普通外科中心2010年3月至2014年12月施行的达芬奇机器人胃癌、结直肠癌手术647例的临床资料.胃癌手术305例,包括根治性全胃切除术69例,近端胃大部切除术11例,远端胃大部切除术213例,残胃癌根治术12例.结直肠癌手术342例,包括根治性右半结肠切除术6例,根治性左半结肠切除术4例,横结肠癌根治术1例,乙状结肠癌根治术24例,直肠癌低位前切除术222例,腹会阴联合直肠癌根治术79例,经腹直肠癌切除、近端造口、远端封闭术6例.结果 647例达芬奇机器人胃癌及结直肠癌手术中,4例胃癌及2例直肠癌中转为开腹手术,其余手术均获成功.胃癌手术平均时间（226±62） min,平均出血量（125±77） ml,平均清扫淋巴结（34±10）枚;术后平均下床活动时间为（3.2±1.5）d,平均胃肠功能恢复时间为（3.1±1.3）d,平均进流质饮食时间为（3.5±1.9）d,术后平均住院时间（7.9±3.7）d,术后并发症发生率9.2％ （28/305）,均经治疗后痊愈出院.结直肠癌手术平均时间（181±61） min,平均出血量（110±93） ml,平均清扫淋巴结（19±6）枚,术后平均下床活动时间（2.9±1.5）d,平均胃肠功能恢复时间（2.7±1.7）d,术后平均住院时间（7.1±1.6）d,术后并发症发生率8.8％（30/342）,经治疗后痊愈出院,术后近期效果良好.结论 达芬奇机器人胃癌及结直肠癌根治术安全可行,创伤小、恢复快,近期疗效好.

Objective To investigate the feasibility and safety of robotic-assisted radical resection of gastric and colorectal cancer.Methods The clinical data of 305 patients who received radical resection of gastric cancer and 342 patients who received radical resection of colorectal cancer both accomplished by the da Vinci robotic surgical system at the Southwest Hospital,Third Military Medical University from March 2010 to December 2014 were retrospectively analyzed.In gastric cancer group,radical total gastrectomy were performed in 69 cases,proximal gastrectomy in 11 cases,distal gastrectomy in 213 cases and 12 cases of gastric stump cancer.In colorectal cancer group,radical resection of the right colon were performed in 6 cases,left colon in 4 cases,transverse colon in 1 case,sigmoid colon low anterior resection procedure in 24 cases,rectal low anterior resection procedure in 222 cases,abdominoperineal excision procedure in 79 cases and Hartmann procedure in 6 cases.Results All cases had robotic-assisted radical resection successfully.In gastric cancer group,the mean operation time was （226 ± 62） minutes,the mean blood loss was （125 ±77） ml,the mean number of harvested lymph nodes was 34 ± 10;the mean time for patients taking normal activity was （3.2 ± 1.5） days,the mean time for gastrointestinal function recovery was （3.1 ± 1.3） days,the mean time for taking liquid food was （3.5 ± 1.9） days.The mean hospitalization was （7.9 ± 3.7） days postoperatively.In colorectal group,the mean operation time was （181 ± 61）minutes,the mean blood loss was （110 ± 93） ml,the mean number of harvested lymph nodes was 19 ± 6;the mean time for patients taking normal activity was （2.9 ± 1.5） days,passage of first flatus was （2.7 ±1.7） days.The mean hospitalization was （7.1 ± 1.6） days postoperatively.Surgical complications occurred in 28 patients （9.2%） of gastric cancer group and 30 patients （8.8%） of colorectal cancer group,all the cases were recovery before leaving hospital with non-operation therapy.The short-term efficiency was obvious.Conclusion Robotic-assisted radical resection for gastric and colorectal cancer is a feasible and safe surgical procedure combined the minimal trauma and fast recovery.