机器人辅助直肠癌根治术(附179例报告)

Robotic-assisted radical resection in rectal cancer: a report of 179 cases

目的:探讨机器人辅助直肠癌根治术的安全性、可行性及肿瘤根治性。方法:回顾性分析我科自2015年9月至2018年1月,采用达芬奇~机器人手术系统开展直肠癌根治术179例,其中肿块下缘位于腹膜反折以上者100例,以下者79例。结果:179例机器人辅助直肠癌根治术均获成功,共完成保肛手术158例。4例伴肝转移的Ⅳ期病人同时切除肝转移灶。平均手术时间(154±44) min,中位出血量50 mL,平均清扫淋巴结(15.4±5.4)枚。病人术后(4.0±2.1) d开始进食流质,术后平均住院(7.6±3.1) d。发生并发症5例(2.79%),均为吻合口漏,未再次手术。学习曲线分析显示,17例后跨越学习曲线。结论:机器人辅助直肠癌根治术安全可行,创伤小、恢复快,近期疗效好。

Objective To investigate the feasibility and safety of robotic-assisted rectal cancer radical resection.Methods The clinical data of 179 patients with rectal cancer who underwent robotic-assisted radical resection using da Vinci~ Robotic Surgical System in this hospital from September 2015 to January 2018 were retrospectively analyzed including 100 cases with the distal margin of tumor above peritoneal reflection and 79 cases below peritoneal reflection.Results All cases had robotic-assisted rectal cancer radical resection successfully. A total of 158 cases had radical resection with anus preservation. Both rectal cancer and hepatic metastasis were resected in 4 cases with stage Ⅳ. Mean operative time was(154±44) minutes and median blood loss was 50 mL with mean harvested lymph nodes of 15.4±5.4. Liquid diet recovered(4.0±2.1) days after operation. Mean hospital stay was(7.6±3.1) days postoperatively. There were 5 cases(2.79%) with surgical complications as anastomotic leak recovered without surgical intervention. Learning curve analysis showed that passing learning curve was 17 cases later. Conclusions It was indicated that robotic-assisted rectal cancer radical resection is feasible and safe combined with minimal invasion and fast recovery.