达芬奇机器人脾动脉瘤切除重建一例

Robotic splenic aneurysm resection and reconstruction:a case report and literature review

目的探讨利用机器人手术系统行脾动脉瘤切除、端端吻合的可行性及优势。方法2021年2月海军军医大学附属长海医院收治1例脾动脉瘤病例,61岁女性,腹部CT检查发现脾动脉瘤,大小约1.8 cm,行机器人脾动脉瘤切除、血管端端吻合。依照术前标注穿刺位置连接机器人手术系统,打开肝胃韧带,在胰腺上缘显露脾动脉瘤,沿动脉瘤游离出近端流入道、远端流出道,使用动脉阻断夹阻断动脉瘤近端、远端脾动脉,切除动脉瘤,5-0普理灵缝线间断端端吻合脾动脉。结果手术顺利,术中出血50 ml,术后无腹腔出血、感染,术后5 d出院,术后复查上腹部CT提示脾动脉吻合口通畅,脾脏供血良好。结论机器人下脾动脉瘤切除重建安全、可行,血管吻合过程比腹腔镜手术更具优势。

Objective To explore the feasibility and advantages of using robotic surgery system for splenic aneurysm resection and end-to-end anastomosis.Methods A case of splenic aneurysm was admitted in Feb.2021.A 61-year-old woman found a splenic aneurysm by the abdominal CT.The size of the splenic aneurysm was about 1.8 cm.The splenic aneurysm was removed by robot surgery system and end-to-end anastomosis was performed.First,connected the robotic surgery system before surgery,the hepatogastric ligament was partially divided using electric hook,the splenic aneurysm was exposed on the superior margin of the pancreas,isolated the proximal inflow tract and distal outflow tract along the aneurysm,the proximal and distal aneurysm was blocked by the arterial clip.The aneurysm was resected and the splentic artery reconstructed by 5-0 Prolene suture.Results The operation was uneventful.The loss of bleeding was 50 ml.There was no abdominal hemorrhage or infection after the operation.The patient was discharged on the 5 days.The abdominal CT scan showed that the splenic artery anastomosis was unobstructed.Conclusions Robotic resection and reconstruction of splenic aneurysm is safe and feasible,and the vascular anastomosis procedure has more advantages than laparoscopy.