吲哚菁绿荧光实时导航达芬奇Xi机器人肝切除术初步探讨

A preliminary study on real-time navigation of indocyanine green Xi da Vinci robot hepatectomy

目的总结达芬奇Xi机器人联合吲哚菁绿荧光定位肝脏肿瘤实现精准肝切除的经验。方法回顾分析2021年1~5月期间20例吲哚菁绿荧光定位联合达芬奇Xi机器人肝肿瘤切除术患者的临床资料。结果20例均在达芬奇Xi机器人下完成肝肿瘤切除,无中转开腹,手术时间85 min(70~105 min),术中出血量110 ml(50~200 ml),术后住院时间7 d(5~9 d)。术后患者肝功能恢复良好,均未出现出血、胆漏等并发症。术后病理结果:肝细胞肝癌10例、肝细胞异型增生和胆管异形增生1例、胆管细胞癌6例、肝硬化伴肝脏炎性改变1例、腺癌(胃肠道转移)2例。20例均为R0切除,愈合良好出院。结论在熟练完成腹腔镜肝肿瘤切除术的基础上,开展吲哚菁绿荧光定位联合达芬奇Xi机器人手术系统精准肝切除是安全、可行的,具有较高的临床价值及推广意义。

Objective To summarize the experience of precision liver resection by da Vinci Xi robot combined with indocyanine green fluorescence localization for liver tumor.Methods The clinical data of 20 patients with liver tumor resection by indocyanine green fluorescence localization combined with da Vinci Xi robot from Jan.to May 2021 were retrospectively analyzed.Results All 20 patients underwent liver tumor resection with the da Vinci Xi robot without intermediate open abdomen,with an operative time of 85 min(70-105 min),and intraoperative bleeding of 110 ml(50-200 ml).Postoperative hospital stay 7 d(5-9 d).The patients recovered well from postoperative liver function,and none of them had complications such as bleeding or bile leakage.The postoperative pathological results were:10 cases of hepatocellular cancer,1 case of hepatocellular heterogeneous hyperplasia and bile duct heterogeneous hyperplasia,6 cases of bile duct cell carcinoma,1 case of cirrhosis with inflammatory changes in the liver,and 2 cases of adenocarcinoma(gastrointestinal metastasis).20 patients were resected with R0 and discharged with good healing.Conclusions Based on the skillful completion of laparoscopic liver tumor resection,it is safe and feasible to carry out accurate liver resection with indocyanine green fluorescence localization combined with da Vinci Xi robotic surgical system,which has high clinical value and promotion significance.