达芬奇机器人辅助下镜面人胆管结石取石一期成型术

Robotic the primary suture of choledocholithotomy in a patient with situs inversus totalis

目的探讨达芬奇机器人辅助下镜面人胆管切开取石术的临床疗效及优势。方法2020年11月,南通大学附属医院收治1例镜面人胆总管结石病例,62岁男性,MRCP检查提示:肝内胆管及胆总管下段多发结石,胆系扩张;胆囊结石伴胆囊炎。在全身麻醉下使用达芬奇机器人(da Vinci Xi,P8)辅助下胆总管切开取石一期成型术。术后评估患者术中出血量、切口愈合、手术并发症,患者恢复及满意度情况。结果患者术中出血量少,术后恢复好,无腹腔出血、感染,患者满意度高。结论达芬奇机器人辅助下胆管切开取石术具有较传统腹腔镜更加高清的手术视野,面对全内脏反位的镜面人,达芬奇机器人手术系统能清晰地显示解剖结构,避免思维定式,确保了手术安全。

Objective To explore the feasibility and advantages of using robotic surgery system for the primary suture of choledocholithotomy in a patient with situs inversus totalis.Methods A case of choledocholithotomy in a patient with situs inversus totalis was admitted in Nov.2020.A 62-year-old man found cholangiolithiasis by the abdominal MRI.Multiple stones in the intrahepatic bile duct and lower segment of the common bile duct with dilated biliary system;Cholecystolithiasis with cholecystitis.The primary suture of choledocholithotomy under general anesthesia assisted by da Vinci Xi(P8).The intraoperative bleeding,wound healing,surgical complications,patient recovery and patient satisfaction were evaluated.Results The operation was uneventful.The patient had less intraoperative bleeding and recovered well postoperatively,without intra-abdominal bleeding,infection and no surgical complications occurred.The patient was satisfied with the surgery.Conclusions Robotic the primary suture of choledocholithotomy in a patient with situs inversus totalis has a higher definition of surgical field,safe and precise surgical operation than conventional laparoscopy.Da Vinci robot surgical system can clearly show the anatomical structure,avoid mode of thinking,ensure surgical safety.