腹腔镜超声在机器人辅助肝切除术中应用的初步探讨

Application of intraoperative ultrasonography in robot-assisted iaparoscopic hepatectomy

目的探讨腹腔镜超声在机器人辅助肝切除手术中的应用及意义。方法收集并分析135例实施机器人辅助肝切除术患者的基本信息、手术过程、手术预后等。135例患者均辅助使用术中腹腔镜超声，通过探测、辨别、导航和确认四个步骤，辅助肝肿瘤的定位和切除。在必要情况下，术中腹腔镜超声引导肝内肿瘤微波消融以完善手术治疗。结果135例患者中11例患者发现11个术前未被发现的病灶，其中7例患者做了治疗方案的调整：4例扩大了肝脏切除范围，3例使用了术中腹腔镜超声引导下微波消融治疗。所有病例中，仅17例患者失血〉1000ml，无器官功能障碍和死亡病例。结论机器人辅助肝切除手术中，腹腔镜超声能够明确病灶情况及肝内血管走行，确认肿瘤的完整切除，也是辅助肝脏肿瘤微波消融治疗必不可少的工具。

Objective To explore the application and significance of intraoperative laparoscopic ultrasound（IOUS） in robot-assisted laparoscopic hepatectomy. Methods From February 2015 to February 2017,135 patients undergoing liver resection with robotic approach were enrolled in the study. All data about demographic, surgical procedure and postoperative course were collected prospectively and analyzed. IOUS was routinely performed in these patients. To assist the localization and resection of liver tumor, a four steps IOUS protocol in robotic liver surgery was proposed, including exploration, verification, guidance, and confirmation. If necessary, intraoperative laparoscopic ultrasound guided microwave ablation of liver tumor to complete the treatment. Results A total of 11 additional lesions in 11 patients were detected in 135 patients, 7 patients accepted strategic surgical modification： 4 cases were enlarged resection, and 3 cases were treated with microwave ablation. There were only 17 patients lost blood more than 1 000 ml in all patients. No patient suffered from any single or multiple organ dysfunctions, and there was no mortality observed. Conclusions IOUS is indispensable to understand lesions and vessels, confirm the complete resection of the tumor in robot-assisted laparoscopic hepatectomy. It is also a necessary tool for the microwave ablation of liver tumor.