达芬奇机器人手术系统在肝胆胰外科手术中的应用体会

The application of Da Vinci robot operation system in hepatobiliary and pancreatic surgery

目的总结达芬奇机器人手术系统在肝胆胰外科手术中的临床应用经验。方法回顾性分析本研究中心自2019年09月至2020年07月实施的41例机器人下肝胆胰手术的临床资料。结果共实施达芬奇机器人手术共41例(肝脏手术28例,胰十二指肠切除术13例)。28例机器人肝切除术无中转开腹,平均手术时间240±75 min,术中平均出血量310±90 ml,术中输血4例。术后腹腔出血1例,保守治疗好转;术后微胆漏2例,充分引流后自愈。术后平均带管时间3.8±1.7 d,术后平均住院时间为5.5±2.5 d,无围手术期死亡。15肝细胞癌患者术后随访未见复发、转移。13例胰十二指肠切除术中,2例中转开腹,余11例顺利完成手术,均为R0切除。平均手术时间427±125 min,平均胰肠吻合时间38±14.5 min,平均胆肠吻合时间20.5±8.5 min,术中平均出血量325±105 ml,术中出血量大于800 ml 2例,术中输血3例,术后输血2例。术后A级胰漏3例,B级胰漏2例,C级胰漏1例(术后腹腔出血,保守治疗好转)。术后平均进食水时间7.4±2.6 d,术后平均带管时间7.8±3.4 d,术后平均住院时间为15.5±4.8 d,无围手术期死亡。13例患者术后依据病理结果行化疗,随访未见复发、转移病例。结论机器人肝胆胰手术安全、有效,在腹腔镜操作困难肝段及复杂的消化道重建方面具有较大优势。

Objective To summarize the clinical application of Da Vinci robot surgical system in hepatobiliary and pancreatic surgery.Methods The data of 41 cases underwent hepatobiliary and pancreatic surgery performed by Da Vinci robot in the research center from September 2019 to July 2020 were retrospectively analyzed.Results A total of 41 cases(28 cases with liver surgery,13 cases underwent pancreaticoduodenectomy)were performed by Da Vinci robot.The average operative time in 28 cases of robotic hepatectomy was 240±75 min,the average intraoperative blood loss was 310±90 ml,and blood transfusion was performed in 4 cases.Postoperative celiac hemorrhage in 1 case was cured by conservative treatment.Postoperative microbile leakage occurred in 2 cases,but recovered after adequate drainage.The average postoperative catheter duration was 3.8±1.7 d,the average postoperative hospital stay was5.5±2.5 d,no conversion to laparotomy and no perioperative death occurred.No recurrence or metastasis was observed in patients with hepatocellular carcinoma.Among the 13 cases of pancreaticoduodenectomy,2 cases were converted to laparotomy,and the remaining 11 cases were successfully completed,all of which were R0 resection.The mean operative time was 427±125 min,the mean pancreaticointestinal anastomosis was 38±14.5 min,the mean choleoenteric anastomosis was 20.5±8.5 min,the mean intraoperative blood loss was 325±105 ml,the intraoperative blood loss was more than 800 ml in 2 cases,the intraoperative blood transfusion was 3 cases,and the postoperative blood transfusion was 2 cases.There were 3 cases of grade A pancreatic leakage,2 cases of grade B pancreatic leakage and 1 case of grade C pancreatic leakage(postoperative abdominal hemorrhage,conservative treatment was improved).The average postoperative water intake time was 7.4±2.6 d,the average postoperative catheter wearing time was 7.8±3.4 d,the average postoperative hospital stay was 15.5±4.8 d,and there was no perioperative death.The patient received postoperative chemotherapy based on pathological results,and no recurrence or metastasis was found.Conclusions The robotic hepatobiliary and pancreatic surgery is safe and effective,and has more advantages in difficult laparoscopic operation in liver segments and complex digestive tract reconstruction.