新一代达芬奇机器人低位直肠前切除经自然腔道标本拖出术临床应用

The clinical application of the low rectal anterior resection with the nature orifice specimen extraction assisted by the new generation of da Vinci robots

目的探讨新一代达芬奇机器人低位直肠前切除经自然腔道标本拖出术的近期临床疗效。方法回顾性分析重庆大学附属三峡医院肠道外科2019年5月至10月35例直肠癌患者在新一代达芬奇机器人低位直肠前切除经自然腔道标本拖出术的临床资料,分析临床病理特征、围手术期相关结果及术后随访资料。结果35例低位直肠癌患者在新一代达芬奇机器人下顺利完成了低位直肠前切除术,无中转开腹,全部顺利出院。手术时间(130.27±42.16)min,术中出血量(105.83±86.20)ml,术中无副损伤,术中腹腔冲洗液细菌培养未发现细菌生长;术后下床时间(2.32±0.35)d,术后肛门排气时间(2.87±1.08)d,术后进食时间(3.86±1.41)d,术后拔除腹腔引流管时间(4.38±1.26)d,术后住院时间(8.21±1.90)d,淋巴结清扫数目(18.98±3.11)枚,术后肿瘤远端切缘(2.81±1.03)cm,术后肿瘤近端切缘(12.39±2.30)cm,术后环周切缘均为阴性,术后系膜完整,未出现直肠系膜破裂,术后出现吻合口瘘1例,通过引流痊愈;术后未出现盆腔感染、肺部、泌尿系感染、肠梗阻、静脉栓塞等并发症;术后随访1个月,未发现明显排尿困难、性功能障碍和便失禁。结论新一代达芬奇机器人低位直肠前切除经自然腔道标本拖出术近期疗效较好,安全可行,具有很好的临床运用价值。

Objective To investigate the short-term efficacy of the low rectal anterior resection assisted by the da Vinci robot′s new generation of surgical systems.Methods The clinicopathological features,perioperative results and postoperative follow-up data of 35 cases of low rectal cancer with low rectal anterior resection via nature orifice specimen extraction assisted by the new generation of da Vinci robots retrospectively analyzed in the intestinal surgery department of the San Xia Hospital Affiliated to Chongqing University from May to Oct.2019.Results The 35 patients with low rectal cancer performed the low rectal anterior resection via nature orifice specimen extraction assisted by the new generation of da Vinci robots were successfully discharged and no patients were converted into open surgery.The operation time was(130.27±42.16)min,and the intraoperative blood loss was(105.83±86.20)ml.There was no side injury during the operation,and no bacterial growth was found in the bacterial culture of intraoperative abdominal washing fluid,postoperative activity time was(2.32±0.35)days,postoperative anal exhaust time was(2.87±1.08)days,postoperative feeding time was(3.86±1.41)days,postoperative abdominal drainage tube pull time was(4.38±1.26)days,postoperative hospital stay was(8.21±1.90)days,lymph node cleaned the number was(18.98±3.11),postoperative tumor far cut edge was(2.81±1.03)cm,postoperative tumor proximal cut edge was(12.39±2.30)cm,postoperative circumferential cutting edge are negative,postoperative mesorectum complete and does not appear mesorectum burst.One patient occurred anastomotic fistula after surgery and was cured by drainage.No pelvic infection,pulmonary infection,urinary tract infection,intestinal obstruction,venous embolism and other complications occurred.After follow-up of one month,no significant dysuria,sexual dysfunction and defecation incontinence were found.Conclusions The surgery with low rectal anterior resection via nature orifice specimen extraction assisted by the new generation of da Vinci robots has good short-term efficacy,safety and feasibility and has good clinical application value.