The laparoscopic technique in distal pancreatic resection(LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved,partly due to improved postoperative safety and recovery, thus...The laparoscopic technique in distal pancreatic resection(LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved,partly due to improved postoperative safety and recovery, thus optimizing treatment with adjuvant chemotherapy. But laparoscopic pancreaticoduodenectomy(LPD or Whipple-procedures) has spread more slowly, due to the complexity of the procedure. Surgical safety has been a problem in hospitals with low patient volume, resulting in raised postoperative mortality, requiring careful monitoring of outcome during the surgical learning curve. Robotic assistance is expected to improve surgical safety, but data on long term oncological outcome of laparoscopic Whipple procedures with or without robotic assistance is scarce. Future research should still focus surgical safety, but most importantly long term outcome, recorded as recurrence at maximal follow up or-at best-overall long term survival(OS). Available data show median survival above 2.5 years, five year OS more than 30% after LDP even in series with suboptimal adjuvant chemotherapy. Also after LPD, long term survival is reported equal to or longer than open resection. However, surgical safety during the learning curve of LPD is a problem, which hopefully can be facilitated by robotic assistance. Patient reported outcome should also be an endpoint in future trials, including patients with pancreatic ductal adenocarcinoma.展开更多
目的:对比并评估达芬奇机器人手术与传统腹腔镜手术治疗妊娠期附件包块的效果,分析达芬奇机器人手术治疗妊娠期附件包块的安全性及可行性。方法:收集2019年1月—2023年1月郑州大学第一附属医院妇科收治的57例妊娠期附件包块患者的临床资...目的:对比并评估达芬奇机器人手术与传统腹腔镜手术治疗妊娠期附件包块的效果,分析达芬奇机器人手术治疗妊娠期附件包块的安全性及可行性。方法:收集2019年1月—2023年1月郑州大学第一附属医院妇科收治的57例妊娠期附件包块患者的临床资料,按手术方式不同分为机器人组(n=17)和传统腹腔镜组(n=40)。比较两组患者的一般情况资料、围手术期资料、妊娠结局、终止妊娠方式及新生儿结局。结果:两组患者的年龄、体质指数、既往腹部手术史发生率、产次、糖类抗原125、附件包块侧性、附件包块性质、术后并发症发生率、附件包块病理类型相比,差异均无统计学意义(P>0.05)。与传统腹腔镜组相比,机器人组患者孕周更长,附件包块直径更大,急诊手术率更低,手术时间更短,术中估计失血量更少,术后排气时间更短,术后住院时间更短,住院总费用更多。两组患者术中均未发生并发症、输血或中转开腹。两组患者的妊娠结局、终止妊娠方式、新生儿出生孕周、新生儿出生体重、新生儿1 min Apgar评分、新生儿5 min Apgar评分及新生儿并发症发生率相比,差异均无统计学意义(P>0.05)。结论:达芬奇机器人手术治疗妊娠期附件包块是安全、有效、可行的。妊娠期附件包块患者接受达芬奇机器人手术与传统腹腔镜手术术后的妊娠结局、终止妊娠方式和新生儿结局相似。与传统腹腔镜手术相比,即使在更大的妊娠期子宫和(或)更大的附件包块而导致手术难度较高的情况下,达芬奇机器人手术仍能表现出手术时间更短、术中出血量更少、术后肠道功能恢复更快、术后住院时间更短等优势。展开更多
文摘The laparoscopic technique in distal pancreatic resection(LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved,partly due to improved postoperative safety and recovery, thus optimizing treatment with adjuvant chemotherapy. But laparoscopic pancreaticoduodenectomy(LPD or Whipple-procedures) has spread more slowly, due to the complexity of the procedure. Surgical safety has been a problem in hospitals with low patient volume, resulting in raised postoperative mortality, requiring careful monitoring of outcome during the surgical learning curve. Robotic assistance is expected to improve surgical safety, but data on long term oncological outcome of laparoscopic Whipple procedures with or without robotic assistance is scarce. Future research should still focus surgical safety, but most importantly long term outcome, recorded as recurrence at maximal follow up or-at best-overall long term survival(OS). Available data show median survival above 2.5 years, five year OS more than 30% after LDP even in series with suboptimal adjuvant chemotherapy. Also after LPD, long term survival is reported equal to or longer than open resection. However, surgical safety during the learning curve of LPD is a problem, which hopefully can be facilitated by robotic assistance. Patient reported outcome should also be an endpoint in future trials, including patients with pancreatic ductal adenocarcinoma.
文摘目的:对比并评估达芬奇机器人手术与传统腹腔镜手术治疗妊娠期附件包块的效果,分析达芬奇机器人手术治疗妊娠期附件包块的安全性及可行性。方法:收集2019年1月—2023年1月郑州大学第一附属医院妇科收治的57例妊娠期附件包块患者的临床资料,按手术方式不同分为机器人组(n=17)和传统腹腔镜组(n=40)。比较两组患者的一般情况资料、围手术期资料、妊娠结局、终止妊娠方式及新生儿结局。结果:两组患者的年龄、体质指数、既往腹部手术史发生率、产次、糖类抗原125、附件包块侧性、附件包块性质、术后并发症发生率、附件包块病理类型相比,差异均无统计学意义(P>0.05)。与传统腹腔镜组相比,机器人组患者孕周更长,附件包块直径更大,急诊手术率更低,手术时间更短,术中估计失血量更少,术后排气时间更短,术后住院时间更短,住院总费用更多。两组患者术中均未发生并发症、输血或中转开腹。两组患者的妊娠结局、终止妊娠方式、新生儿出生孕周、新生儿出生体重、新生儿1 min Apgar评分、新生儿5 min Apgar评分及新生儿并发症发生率相比,差异均无统计学意义(P>0.05)。结论:达芬奇机器人手术治疗妊娠期附件包块是安全、有效、可行的。妊娠期附件包块患者接受达芬奇机器人手术与传统腹腔镜手术术后的妊娠结局、终止妊娠方式和新生儿结局相似。与传统腹腔镜手术相比,即使在更大的妊娠期子宫和(或)更大的附件包块而导致手术难度较高的情况下,达芬奇机器人手术仍能表现出手术时间更短、术中出血量更少、术后肠道功能恢复更快、术后住院时间更短等优势。
