三维医学重建联合达芬奇机器人技术在肝切除术中的临床应用

CLINICAL APPLICATION OF THREE-DIMENSIONAL MEDICAL RECONSTRUCTION COMBINED WITH DA VINCI ROBOTIC TECHNOLOGY IN HEPATECTOMY

目的总结CAS三维医学重建联合达芬奇机器人肝切除术的初步经验。方法回顾性分析我院2014年12月—2019年3月行CAS三维医学重建联合达芬奇机器人肝切除术107例病人的临床资料。结果 107例中105例完成机器人下肝切除术,2例中转开腹,中转率为1.9%。平均手术时间(235.3±35.2)min,术中失血量(144.0±18.6)mL,术中输血比例为9.3%,术后并发症发生率为12.1%,术后住院时间为(7.5±2.3)d。11例肝胆管结石病病人术中结石清除率为95.5%。围手术期无死亡病例。随访时间为2～50个月,平均(21.8±13.0)个月,69例恶性肿瘤中18例复发,其中5例死亡,13例带瘤生存,其余51例健康生存,无复发转移;11例肝胆管结石病人均无复发,2例出现胆管炎症状,接受药物治疗后好转。结论针对性地应用CAS三维医学重建技术有助于肝脏外科疾病病人的术前诊断、手术方式的选择、病灶可切性分析,并可缩短术中决策时间、进行术中指导等,从而降低手术风险。CAS三维医学重建联合达芬奇机器人行肝切除术安全可行、疗效确切,具有微创手术的优势。

Objective To summarize the preliminary experience of applying CAS three-dimensional medical reconstruction combined with da Vinci robot in hepatectomy. Methods A retrospective analysis was conducted on the clinical data of 107 patients who underwent hepatectomy using CAS three-dimensional medical reconstruction combined with da Vinci robot in our hospital from December 2014 to March 2019. Results Of the 107 patients,105 completed the robot-assisted laparoscopic hepatectomy,and 2(1.9%)were converted to open surgery during operation.The mean time of operation was(235.3±35.2)min,the intraoperative blood loss was(144.0±18.6)mL,the intraoperative blood transfusion rate was 9.3%,the postoperative complication rate was 12.1%,and the length of postoperative hospital stay was(7.5±2.3)d.The intraoperative stone clearance rate for 11 patients with hepatolithiasis was 95.5%.There were no deaths during the perioperative period.The follow-up period lasted for 2 to 50 months,with a mean of(21.8±13.0)months.Of the 69 patients with malignant tumors,18 relapsed,5 of them died,and 13 survived with tumor,the remaining 51 survived without any recurrence or metastasis.Of the 11 patients with hepatolithiasis,none had a relapse,and 2 patients had symptoms of cholangitis and recovered after treatment with medications. Conclusion Targeted application of CAS three-dimensional medical reconstruction technology contributes to the preoperative diagnosis,selection of surgical methods and analysis of lesion appropriateness of patients with liver surgical diseases;meanwhile,it can shorten the time of intraoperative decision-making,and intraoperative guidance,reduce the risk of surgery.CAS three-dimensional medical reconstruction combined with da Vinci robot for hepatectomy is safe,feasible,and effective,and has the advantages of minimally invasive surgery.