腹腔镜辅助达芬奇手术系统治疗直肠癌的临床体会(附268例报告)

Clinical experience of laparoscopic-assisted da Vinci robotic surgical system in the treatment of rectal neoplasms: with a report of 268 cases

目的:探讨达芬奇机器人手术系统联合腹腔镜直肠癌根治术的可行性、安全性及近期疗效。方法:回顾分析2011年5月至2016年5月为268例直肠癌患者行达芬奇机器人手术系统联合腹腔镜手术的临床资料,系统分析手术方法、术式选择、并发症及术后近期恢复情况。结果:267例完成达芬奇机器人手术系统联合腹腔镜手术,1例中转开腹。199例采用前切除术(Dixon),57例行经腹会阴联合切除术(Miles),12例行远端闭锁近端造口术(Hartmann),手术时间分别为(193±33)min、(181±37)min与(173±24)min,术中出血量分别为(27±8)ml、(36±10)ml与(29±12)ml。未行术前新辅助放化疗的患者平均清扫淋巴结(15.4±4.1)枚,行术前新辅助放化疗的患者平均(11.2±2.8)枚。直肠远切缘平均(3.5±0.8)cm,均为阴性;环周切缘5例阳性。术后排气时间平均(3.0±0.8)d,拔除尿管时间平均(3.0±0.6)d。术后发生吻合口瘘6例、肠梗阻10例、手术相关性感染12例,无围手术期死亡病例。结论:达芬奇机器人手术系统联合腹腔镜用于直肠癌根治术安全、可行。

Objective： To investigate the feasibility,safety and short-term efficacy of hybrid method combined traditional laparoscopy with da Vinci robotic surgical system in rectal neoplasms radical operation. Methods： Retrospectively analysis was made on the clinical data of 268 patients who suffered from rectal neoplasms and underwent da Vinci robotic and laparoscopic radical operation from May 2011 to May 2016. Systematic evaluation was focused on operative procedure,operation selection,complications and short-term recovery. Results： The da Vinci robotic and laparoscopic operation was successful in 267 patients while one was converted to open procedure. The procedure included 199 anterior resections,57 abdominoperineal resections and 12 Hartmann. The mean operative time was（ 193 ± 33） min,（ 181 ± 37） min and（ 173 ± 24） min respectively,and the mean blood loss was（ 27 ± 8） ml,（ 36 ± 10） ml and（ 29 ±12） ml. The mean number of harvested lymph nodes with or without preoperative neoadjuvant chemoradiotherapy was（ 11. 2 ± 2. 8） and（ 15. 4 ± 4. 1） respectively. The distal margin was（ 3. 5 ± 0. 8） cm without residual cancer cells. Five patients possessed positive circumferential resection margin. Passage of first flatus was（ 3. 0 ± 0. 8） d. The time of urinary catheter removed was（ 3. 0 ± 0. 6） d.Anastomotic fistula（ n = 6）,intestinal obstruction（ n = 10） and surgery related infection（ n = 12） were found without perioperative death. Conclusions： The da Vinci robotic surgical system and laparoscopy is a safe and feasible technique for radical operation of rectal cancer.