达芬奇机器人手术系统在直肠癌根治术侧方淋巴结清扫中的应用

Application of Da Vinci robotic surgery system in lateral lymph node dissection for radical resection of rectal cancer

目的观察达芬奇机器人手术系统在直肠癌根治术侧方淋巴结清扫中的应用效果。方法 40例直肠癌患者,根据侧方淋巴结情况分为MRI阳性(淋巴结长径≥5 mm)组17例、MRI阴性(淋巴结长径<5 mm)组23例。两组均行达芬奇机器人手术系统辅助侧方淋巴结清扫直肠癌根治术(Dixon),观察并记录两组清扫侧方淋巴结区域时间、清扫淋巴结数、侧方淋巴结转移数量、侧方淋巴结转移患者数,记录两组术后住院时间及术后排尿障碍和淋巴漏等并发症发生情况。结果 40例患者均成功完成手术,侧方淋巴结清扫时间59.88 min,清扫侧方淋巴结267枚,其中转移淋巴结15枚,淋巴结总转移率5.61%,7例患者存在侧方淋巴结转移;平均住院时间7.73天,术后分别有2例患者发生淋巴漏、3例患者发生排尿障碍。与MRI阳性组比较、MRI阴性组侧方淋巴结转移率、患者淋巴结转移率降低(P均<0.05),两组间侧方淋巴结清扫时间、清扫侧方淋巴结数、手术时间、术后淋巴漏及排尿障碍发生情况间比较差异无统计学意义。结论达芬奇机器人手术系统对于直肠癌侧方淋巴结清扫安全、便捷、可操作性强。MRI检查中侧方位淋巴结长径≥5 mm的直肠癌患者应行侧方淋巴结清扫。

Objective To observe the effect of Da Vinci robotic surgery system on lateral lymph node dissection in radical resection of rectal cancer. Methods According to the lateral lymph nodes,40 patients with low rectal cancer were divided into 17 cases of MRI positive group（lymph node length ≥ 5 mm） and 23 cases of MRI negative group（lymph node length 5 mm）. All the patients successfully completed lateral lymph node dissection of radical resection of rectal cancer（Dixon） with Da Vinci robotic surgical system. The clinical data of the patients between groups were observed and recorded,including the time of dissection of the lateral lymph nodes,the number of lymph nodes,the number of lateral lymph node metastases,the number of side lymph node metastases,the time of postoperative hospitalization,postoperative urination disorders and lymphatic leakage,etc. Results We successfully completed the operation on 40 patients with Da Vinci robot surgery system. The average time of dissection of lateral lymph nodes was 59. 88 min. The number of lateral lymph nodes dissected was 267,of which 15 had metastases with the rate of lymphatic metastasis of 5. 61%. Lymphatic metastasis occurred in 7 of all patients. The average postoperative hospital stay was 7. 73 days,and lymphatic leakage and dysuria were found in 2 and 3 cases,respectively. The lateral lymph node metastasis rate and total lymph node metastasis rate in the MRI negative group were lower than those in the positive group（all P〈0. 05）. There were no significant differences in the lateral lymph node dissection time,the number of lateral lymph nodes,the operation time,the postoperative lymphatic leakage and the occurrence of urination disorder between the two groups. Conclusions Da Vinci＇s robotic surgery system is worth popularizing because of safety,convenience and good maneuverability for lateral lymph node dissection of rectal cancer. Patients should receive the lateral lymph node dissection if the lateral lymph node length exceeds 5 mm.