达芬奇机器人手术系统辅助保留幽门及迷走神经的胃部分切除术

Da Vinci robot⁃assisted pylorus and vagus nerve⁃preserving partial gastrectomy for gastric cancer

目的探讨达芬奇机器人系统辅助保留幽门及迷走神经的胃部分切除术(PPG)治疗胃癌的安全性与可行性。方法采用描述性病例系列研究方法,回顾性分析2020年12月至2021年2月期间,大连医科大学附属第一医院实施的3例达芬奇机器人手术系统辅助的PPG胃癌患者的病例资料。戳卡设置采用“一”字布局,共轴方向为脐与脾门连线。幽门下动、静脉需要保留。以胃网膜右血管与幽门下血管分叉处为中心,从上、下、右、左四个方向及腹侧和背侧两个面进行游离和显露,完成幽门下区淋巴结的清扫。胰腺上缘的处理采用右侧膈肌脚入路法、左侧后腹膜腔入路法以及食管入路法相结合的策略来确定迷走神经后干及其属支分布,并判断与胃左血管的解剖关系。保留迷走神经腹腔支和胃左血管贲门支离断胃左血管。淋巴结清扫的操作层面在血管周围神经纤维外侧。结果3例患者均顺利完成机器人手术,无转腹腔镜或开腹手术。手术时间(340.0±26.4)(300~390)min,术中出血量(13.3±3.3)(10~20)ml,清扫淋巴结(26.7±3.9)(19~32)枚,保留幽门管长度(3.3±0.3)(3~4)cm,远端切缘(2.3±0.3)(2~3)cm,近端切缘(3.0±0.6)(2~4)cm。3例患者均无术后并发症发生。患者首次排气为术后2~3 d,术后住院天数均为术后6~7 d。本组3例患者手术费用为(4.0±0.7)(3.3~5.3)万元。结论达芬奇机器人系统辅助PPG安全可行。

Objective To investigate the safety and feasibility of Da Vinci robot⁃assisted pylorus and vagus nerve⁃preserving partial gastrectomy for gastric cancer.Methods In this study,descriptive case series method was used to retrospectively analyze the data of 3 patients with gastric cancer who underwent Da Vinci robot⁃assisted pylorus and vagus nerve⁃preserving partial gastrectomy in the First Affiliated Hospital of Dalian Medical University from December 2020 to February 2021.The linear layout was adopted for the setting of trocar,and the co⁃axial direction was the line connecting the umbilicus and splenic hilum.The inferior pyloric arteries and veins need to be preserved.The center was the bifurcation of the right gastroepiploic vessel and the inferior pyloric vessel.Dissection and exposure were performed from the upper,lower,right and left sides,and ventral and dorsal sides to complete the dissection of the inferior pyloric lymph nodes.The superior border of the pancreas was treated by the right diaphragmatic crus approach,the left retroperitoneal approach and the esophageal approach to determine the distribution of the posterior vagal trunk and its branches,and to determine the anatomical relationship with the left gastric artery.The left gastric artery was cut off while the celiac branch of vagus nerve and cardia branch of left gastric artery were preserved.Lymph node dissection was performed on the lateral side of nerve fibers around the blood vessels.Result All the 3 patients successfully completed the robotic surgery without conversion to laparoscopy or laparotomy.The operation time was(340.0±26.4)(300⁃390)minutes,the intraoperative blood loss was(13.3±3.3)(10⁃20)ml,the number of dissected lymph nodes was 26.7±3.9(19⁃32),the length of pylorus canal preserved was(3.3±0.3)(3⁃4)cm,the distal margin was(2.3±0.3)(2⁃3)cm,and the proximal margin was(3.0±0.6)(2⁃4)cm.No postoperative complications occurred in all the 3 patients.The first flatus time was 2⁃3 days after operation,and the postoperative hospital stay was 6⁃7 days.The operation cost of the 3 patients was(40±7)(33⁃53)thousand yuan.Conclusion Da Vinci robot⁃assisted pylorus and vagus nerve⁃preserving partial gastrectomy is safe and feasible.