机器人辅助腹腔镜肝切除术的经验初探

Preliminary experience of robotic-assisted laparoscopic liver resection

目的：总结机器人辅助腹腔镜肝切除的初步经验。方法 ：回顾性分析我院2010年1月至2016年1月连续60例达芬奇机器人辅助腹腔镜肝切除术病人的临床资料。结果：60例中57例完成机器人辅助腹腔镜肝切除术,3例中转开腹,中转率为5.0%。平均手术时间（353±121）min,术中失血量（390±287）m L,术中输血率11.7%,术后并发症发生率25.0%（15例）,其中3b级以上发生率3.3%,术后住院时间（9.1±3.3）d。22例肝胆管结石病病人术中结石清除率95.5%,1例残余结石病人术后经T管窦道胆道镜取出,最终结石清除率100%。围手术期无死亡病例。随访时间（18.8±12.0）（2~50）个月,24例恶性肿瘤中7例复发,4例死亡,3例带瘤生存,其余17例健康生存,无复发转移。22例肝胆管结石病人,其中2例复发,均接受再次手术治疗,2例出现胆管炎症状,接受药物治疗后好转。结论：针对选择性病例,机器人辅助腹腔镜肝切除术安全可行、疗效确切,并具有微创手术优势。

Objective To summarize the preminiary experience of robotic-assisted laparoscopic liver resection. Methods The clinical data of 60 consecutive patients who underwent robot-assisted laparosopie liver resections for liver diseases at our institute from Jan 2010 to Jan 2016 were retrospectively analyzed. Results There were 57 cases who received successful robotic-assisted laparoscopic hepatectomy and 3 cases （5.0%） converted to open surgery. Operative time was （353±121） min. Intraoperative blood loss was（390±287） mL with transfusion rate 11.7%. Postoperative complications occurred in 15 cases （25.0%） and complications with Clavien ≥3b accounted for 3.3%. Hospital stay was （9.1±3.3） days. The stone remove rate was 100% （22 cases） including 21 cases with hepatolithiasis（95.5%） removed intraoperatively and 1 case with residual stone successfully removed using choledoehoscopy via a T-tube sinus postoperatively. No death occurred during perioperative period. All cases were followed-up for （18.8±12.0） （2-50）months. During the follow-up period ,7 in 24 cases with cancer were found recurrence and 17 cases without. Among the cases with recurrence,4 cases died and 3 survived with tumor. Two in 22 cases with hepatolithiasis recurred and received reoperation and the other 2 cases experienced chronic cholangitis and resolved after medical treatment. Conclusions Robotic-assisted laparoscopic hepatectomy is safe, feasible and efficacious for selected patients with advantages of minimally invasive surgery.