达芬奇机器人手术系统在残胃癌治疗中的应用:附8例报告
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摘要
目的:探讨达芬奇机器人在残胃癌根治术中应用的可行性、安全性及技术方法。方法:回顾性分析2017年1月—2018年3月收治的8例残胃癌行达芬奇机器人辅助下残胃癌根治术患者临床资料。结果:8例患者均成功施行达芬奇机器人辅助下残胃癌根治术,平均手术时间(237.8±11.0)min,平均术中出血量(147.5±28.2)mL,平均清扫淋巴结(32.3±7.6)枚。术后第1天均拔除胃管,首次下地活动时间平均(1.3±0.2)d,排气时间平均(2.5±0.6)d,首次进流食时间平均(2.7±0.5)d,平均住院时间(7.2±0.5)d。围手术期无死亡病例,术后均未出现腹腔内出血、腹腔感染、吻合口瘘、吻合口狭窄、肠梗阻、切口感染等并发症。8例患者随访6～12个月,期间无死亡病例,患者一般情况良好,未见肿瘤复发。结论:达芬奇机器人应用于残胃癌根治术中是安全、有效、可行的,且手术更加微创、并发症少。
Objective: To investigate the feasibility, safety and technical operations of robotic-assisted radical gastrectomy for gastric stump cancer using Da Vinci robotic system. Methods: Th e clinical data of 8 patients with gastric stump cancer undergoing robotic-assisted radical gastrectomy using Da Vinci robotic system from January 2017 to March 2018 were retrospectively analyzed.Results: Robotic-assisted radical gastrectomy were successfully performed in all of the 8 patients using Da Vinci robotic system. Th e average operative time was(237.8±11.0) min, average intraoperative blood loss was(147.5±28.2) mL, and the average number of dissected lymph nodes was 32.3±7.6. Th e gastric tube was removed on postoperative day one in all patients. Th e average time to postoperative ambulation was(1.3±0.2) d, to fi rst anal gas passage was(2.5±0.6) d, and to liquid intake was(2.7± 0.5) d, and the average length of postoperativehospital stay was(7.2±0.5) d. No death occurred during the perioperative period, and no complications such as intra-abdominal hemorrhage, abdominal infection, anastomotic leakage, anastomotic stricture, intestinal obstruction, and wound infection occurred aft er operation.Conclusion: Using Da Vinci robotic system in radical gastrectomy for gastric stump cancer is safe, effective and feasible. The operation is more minimally invasive, less bleeding, less postoperative pain and less complications.
Objective: To investigate the feasibility, safety and technical operations of robotic-assisted radical gastrectomy for gastric stump cancer using Da Vinci robotic system. Methods: Th e clinical data of 8 patients with gastric stump cancer undergoing robotic-assisted radical gastrectomy using Da Vinci robotic system from January 2017 to March 2018 were retrospectively analyzed.Results: Robotic-assisted radical gastrectomy were successfully performed in all of the 8 patients using Da Vinci robotic system. Th e average operative time was(237.8±11.0) min, average intraoperative blood loss was(147.5±28.2) mL, and the average number of dissected lymph nodes was 32.3±7.6. Th e gastric tube was removed on postoperative day one in all patients. Th e average time to postoperative ambulation was(1.3±0.2) d, to fi rst anal gas passage was(2.5±0.6) d, and to liquid intake was(2.7± 0.5) d, and the average length of postoperativehospital stay was(7.2±0.5) d. No death occurred during the perioperative period, and no complications such as intra-abdominal hemorrhage, abdominal infection, anastomotic leakage, anastomotic stricture, intestinal obstruction, and wound infection occurred aft er operation.Conclusion: Using Da Vinci robotic system in radical gastrectomy for gastric stump cancer is safe, effective and feasible. The operation is more minimally invasive, less bleeding, less postoperative pain and less complications.
引文
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[15]Terashima M,Tokunaga M,Tanizawa Y,et al.Robotic surgery for gastric cancer[J].Gastric Cancer,2015,18(3):449-457.doi:10.1007/s10120-015-0501-4.
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[18]Kim MC,Heo GU,Jung GJ.Robotic gastrectomy for gastric cancer:surgical techniques and clinical merits[J].Surg Endosc,2010,24(3):610-615.doi:10.1007/s00464-009-0618-9.
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[20]张人超,徐晓武,牟一平,等.腹腔镜手术治疗残胃癌7例分析[J].中华胃肠外科杂志,2016,19(5):553-556.doi:10.3760/cma.j.issn.1671-0274.2016.05.017.Zhang RC,Xu XW,Mou YP,et al.Laparoscopic gastrectomy for gastric stump cancer:analysis of 7 cases[J].Chinese Journal of Gastrointestinal Surgery,2016,19(5):553-556.doi:10.3760/cma.j.issn.1671-0274.2016.05.017.
[21]胡祥.残胃复发癌治疗策略[J].中国实用外科杂志,2015,35(10):1075-1078.Hu X.Treatment strategies for gastric stump cancer[J].Chinese Journal of Practical Surgery,2015,35(10):1075-1078.
[22]王沛云,熊兵红,曾玉剑,等.达芬奇机器人与腹腔镜手术治疗胃癌疗效比较的Meta分析[J].中国普通外科杂志,2017,26(4):412-424.doi:10.3978/j.issn.1005-6947.2017.04.003.Wang PY,Xiong BH,Zeng YJ,et al.Meta-analysis of da Vinci robotic versus laparoscopic gastrectomy for gastric cancer[J].Chinese Journal of General Surgery,2017,26(4):412-424.doi:10.3978/j.issn.1005-6947.2017.04.003.
[23]Son T,Hyung WJ.Robotic gastrectomy for gastric cancer[J].J Surg Oncol,2015,112(3):271-278.doi:10.1002/jso.23926.
[24]JunFeng Z,Yan S,Bo T,et al.Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer:comparison of surgical performance and short-term outcomes[J].Surg Endosc,2014,28(6):1779-1787.doi:10.1007/s00464-013-3385-6.
[2]王伟,易小江,万进,等.胃癌腹主动脉旁淋巴结清扫的临床意义[J].中国普通外科杂志,2018,27(4):391-395.doi:10.3978/j.issn.1005-6947.2018.04.001.Wang W,Yi XJ,Wan J,et al.Clinical significance of paraaortic lymph node dissection in gastric cancer[J].Chinese Journal of General Surgery,2018,27(4):391-395.doi:10.3978/j.issn.1005-6947.2018.04.001.
[3]马俊文,马文,韩瑞东.腹腔镜辅助胃癌根治术的临床应用效果及对患者血清学指标的影响[J].中国普通外科杂志,2018,27(4):518-522.doi:10.3978/j.issn.1005-6947.2018.04.019.Ma JW,Ma W,Han RD.Effect of clinical use of laparoscopicassisted radical gastric cancer resection and the infl uence on serum indices of patients[J].Chinese Journal of General Surgery,2018,27(4):518-522.doi:10.3978/j.issn.1005-6947.2018.04.019.
[4]吉翔,王朝阳,石鑫,等.完全腹腔镜下残胃癌根治术的临床应用及近期疗效[J].腹腔镜外科杂志,2017,22(1):36-38.doi:10.13499/j.cnki.fqjwkzz.2017.01.036.Ji X,Wang CY,Shi X,et al.Clinical application and short term effect of total laparoscopic radical gastrectomy for gastric stump cancer[J].Journal of Laparoscopic Surgery,2017,22(1):36-38.doi:10.13499/j.cnki.fqjwkzz.2017.01.036.
[5]寸英丽,查勇.残胃癌的临床病理特征[J].中国普通外科杂志,2009,18(10):1019-1021.Cun YL,Zha Y.Clinicopathological features of gastric remnant cancer[J].Chinese Journal of General Surgery,2009,18(10):1019-1021.
[6]Balfour DC.Factors influencing the life expectancy of patients operated on for gastric ulcer[J].Ann Surg,1922,76(3):405-408.
[7]胡祥.第14版日本《胃癌处理规约》的重要变更[J].中国实用外科杂志,2010,30(4):241-246.Hu X.Essential amendment of the 14th edition of Japanese guidelines for treatment of stomach cancer[J].Chinese Journal of Practical Surgery,2010,30(4):241-246.
[8]Mezhir JJ,Gonen M,Ammori JB,et al.Treatment and outcome of patients with gastric remnant cancer after resection for peptic ulcer disease[J].Ann Surg Oncol,2011,18(3):670-676.doi:10.1245/s10434-010-1425-1.
[9]Sinning C,Schaefer N,Standop J,et al.Gastric stump carcinomaepidemiology and current concepts in pathogenesis and treatment[J].Eur J Surg Oncol,2007,33(2):133-139.doi:10.1016/j.ejso.2006.09.006.
[10]高志冬,李永柏,姜可伟,等.残胃癌诊治的研究进展与争议[J].中华胃肠外科杂志,2018,21(5):588-592.doi:10.3760/cma.j.issn.1671-0274.2018.05.021.Gao ZD,Li YY,Jiang KW,et al.Progress and controversy on diagnosis and treatment of gastric stump cancer[J].Chinese Journal of Gastrointestinal Surgery,2018,21(5):588-592.doi:10.3760/cma.j.issn.1671-0274.2018.05.021.
[11]Iguchi K,Kunisaki C,Sato S,et al.Evaluation of Optimal Lymph Node Dissection in Remnant Gastric Cancer Based on Initial Distal Gastrectomy[J].Anticancer Res,2018,38(3):1677-1683.doi:10.21873/anticanres.12401.
[12]Liao G,Wen S,Xie X,et al.Laparoscopic gastrectomy for remnant gastric cancer:Risk factors associated with conversion and a systematic analysis of literature[J].Int J Surg,2016,34:17-22.doi:10.1016/j.ijsu.2016.08.013.
[13]Stefanidis D,Bailey SB,Kuwada T,et al.Robotic gastric bypass may lead to fewer complications compared with laparoscopy[J].Surg Endosc,2018,32(2):610-616.doi:10.1007/s00464-017-5710-y.
[14]Wang G,Jiang Z,Zhao J,et al.Assessing the safety and effi cacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer:A randomized clinical trial[J].J Surg Oncol,2016,113(4):397-404.doi:10.1002/jso.24146.
[15]Terashima M,Tokunaga M,Tanizawa Y,et al.Robotic surgery for gastric cancer[J].Gastric Cancer,2015,18(3):449-457.doi:10.1007/s10120-015-0501-4.
[16]Yang SY,Roh KH,Kim YN,et al.Surgical Outcomes After Open,Laparoscopic,and Robotic Gastrectomy for Gastric Cancer[J].Ann Surg Oncol,2017,24(7):1770-1777.doi:10.1245/s10434-017-5851-1.
[17]Parisi A,Reim D,Borghi F,et al.Minimally invasive surgery for gastric cancer:A comparison between robotic,laparoscopic and open surgery[J].World J Gastroenterol,2017,23(13):2376-2384.doi:10.3748/wjg.v23.i13.2376.
[18]Kim MC,Heo GU,Jung GJ.Robotic gastrectomy for gastric cancer:surgical techniques and clinical merits[J].Surg Endosc,2010,24(3):610-615.doi:10.1007/s00464-009-0618-9.
[19]Firat O,Guler A,Sozbilen M,et al.Gastric remnant cancer:an old problem with novel concerns[J].Langenbecks Arch Surg,2009,394(1):93-97.doi:10.1007/s00423-008-0382-7.
[20]张人超,徐晓武,牟一平,等.腹腔镜手术治疗残胃癌7例分析[J].中华胃肠外科杂志,2016,19(5):553-556.doi:10.3760/cma.j.issn.1671-0274.2016.05.017.Zhang RC,Xu XW,Mou YP,et al.Laparoscopic gastrectomy for gastric stump cancer:analysis of 7 cases[J].Chinese Journal of Gastrointestinal Surgery,2016,19(5):553-556.doi:10.3760/cma.j.issn.1671-0274.2016.05.017.
[21]胡祥.残胃复发癌治疗策略[J].中国实用外科杂志,2015,35(10):1075-1078.Hu X.Treatment strategies for gastric stump cancer[J].Chinese Journal of Practical Surgery,2015,35(10):1075-1078.
[22]王沛云,熊兵红,曾玉剑,等.达芬奇机器人与腹腔镜手术治疗胃癌疗效比较的Meta分析[J].中国普通外科杂志,2017,26(4):412-424.doi:10.3978/j.issn.1005-6947.2017.04.003.Wang PY,Xiong BH,Zeng YJ,et al.Meta-analysis of da Vinci robotic versus laparoscopic gastrectomy for gastric cancer[J].Chinese Journal of General Surgery,2017,26(4):412-424.doi:10.3978/j.issn.1005-6947.2017.04.003.
[23]Son T,Hyung WJ.Robotic gastrectomy for gastric cancer[J].J Surg Oncol,2015,112(3):271-278.doi:10.1002/jso.23926.
[24]JunFeng Z,Yan S,Bo T,et al.Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer:comparison of surgical performance and short-term outcomes[J].Surg Endosc,2014,28(6):1779-1787.doi:10.1007/s00464-013-3385-6.