完全机器人手术系统联合术中胃镜行保留幽门的中段胃切除在胃体癌的应用

Completely robotic surgical system combined with intraoperative gastroscopy for pylorus-preserving midgastrectomy in gastric body cancer

目的探讨完全机器人手术系统联合术中胃镜行保留幽门的中段胃切除治疗中段胃体癌的可行性及安全性。方法采用描述性病例系列研究方法,回顾性收集并分析2023年5月至2023年9月期间中南大学湘雅二医院胃肠外科完成的7例完全机器人手术系统联合术中胃镜行双镜联合的保留幽门的中段胃体癌根治术的临床资料。术中胃镜钛夹定位病变位置,采用5孔法放置Trocar,完全机器人下行中段胃切除,行胃底胃体端端手工缝合。观察手术情况、围手术期情况和术后病理以及随访情况。计量资料采用平均数(范围)或M(范围)来表示,计数资料用频数表示。结果7例患者手术均成功实施完全机器人手术系统联合术中胃镜行双镜联合的保留幽门的中段胃体癌根治术,无中转开腹或术中输血。全组患者全组患者平均手术时间182(165~195)min,平均术中出血量45(40~60)ml,平均手术切口长度3.3(3.0~4.0)cm,平均术后排气时间为2.4(2.0~3.0)d,平均术后首次排便时间3.0(2.0~4.0)d,平均术后进流食时间为3.9(3.0~5.0)d,平均术后住院天数为7.6(7.0~9.0)d,平均术后拔出腹腔引流管时间为4.9(4.0~6.0)d,平均术后拔除尿管时间1.3(1.0~2.0)d,平均术后首次下床活动时间2.3(2.0~3.0)d,住院期间无严重手术相关并发症发生。电话随访患者术后6个月,全组术后切口愈合良好,无术后胃穿孔、术后吻合口出血、吻合口瘘、吻合口狭窄、无胃瘫或无病人出现严重营养不良,仅1例患者出现胃排空障碍导致的反酸、嗳气、腹胀轻微症状,其他患者均无严重餐后不适或胆汁反流性胃炎症状,主观整体营养评分均在A或B级,无病人发生肿瘤复发,转移或死亡,所有患者术后饮食、排便规律,生活质量满意。结论完全机器人手术系统联合术中胃镜行保留幽门的中段胃切除在胃体癌中具有独特优势,具有良好的安全性和可行性,且术后短期预后良好,有利于改善病人术后生活质量。

Objective To investigate the feasibility and safety of a fully robotic surgical system combined with intraoperative gastroscopy for pylorus-sparing midstream gastrectomy in the treatment of midstream gastric carcinoma.Methods A descriptive case series study was used to retrospectively collect and analyze the clinical data of 7 cases of pylorus-preserving radical mesogastric body cancer resections performed by the Department of Gastrointestinal Surgery at the Second Hospital of Xiangya,Central South University,between May 2023 and September 2023 with the combination of a fully robotic surgical system and an intraoperative gastroscope in a two-scope combination.Intraoperative gastroscopic titanium clip was used to localize the lesion location,Trocar was placed by 5-hole method,and midgastric resection was performed under the complete robot,and end-to-end manual suture of gastric fundus and gastric body was performed.The operation,perioperative condition and postoperative pathology as well as follow-up were observed.Measurement information is expressed as mean(range)or M(range),and count information is expressed as frequency.Results All 7 patients successfully underwent radical resection of pylorus-preserving mid-segment gastric carcinoma with a complete robotic surgical system combined with intraoperative gastroscopy and double endoscopy,without conversion laparotomy or intraoperative blood transfusion.The average operation time was 182(165~195)min,the average intraoperative blood loss was 45(40~60)ml,the average surgical incorporation length was 3.3(3.0~4.0)cm,the average postoperative exhaust time was 2.4(2.0~3.0)days,the average postoperative first defecation time was 3.0(2.0~4.0)days,the average postoperative intake time was 3.9(3.0~5.0)days,the average postoperative hospital stay was 7.6(7.0~9.0)days,and the average postoperative time to remove the abdominal drainage tube was 4.9(4.0~6.0)d,the average postoperative urinary catheter removal time was 1.3(1.0~2.0)days,the average postoperative first postoperative activity time was 2.3(2.0~3.0)days,and there were no serious operation-related complications during hospitalization.Telephone follow-up patients were followed up for 6 months after surgery,and the postoperative incision healed well in all groups,and there were no postoperative gastric perforation,postoperative anastomotic bleeding,anastomotic leakage,anastomotic stenosis,no gastric paralysis or severe malnutrition,only one patient had mild symptoms of acid reflux,belching and abdominal distension caused by gastric emptying disorders,and none of the other patients had severe postprandial discomfort or symptoms of bile reflux gastritis,and the subjective overall nutritional scores were all in grade A or B,and no patients had tumor recurrence,metastasis or death.Regular bowel movements,satisfactory quality of life.Conclusion The complete robotic surgical system combined with intraoperative gastroscopy for pylorus-preserving mid-segment gastrectomy has unique advantages,good safety and feasibility,and a good short-term prognosis after surgery,which is conducive to improving the postoperative quality of life of patients.