机器人辅助胰腺微创手术使医患受益的新探讨
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摘要
目的探讨机器人辅助胰腺微创手术给医患双方带来的益处。方法回顾总结本院358例达芬奇机器人系统辅助胰腺微创手术患者的临床资料(胰十二指肠切除术105例,胰中段切除术61例,胰体尾切除术145例,Beger’s术18例,肿块局部切除术29例)。探讨不同部位胰腺肿瘤在手术方式和消化道重建方式上的差异。进一步结合患者的临床资料(年龄、性别、手术时间、术中出血、术后住院时间、术后并发症等),体现机器人手术系统在胰腺微创手术中的价值。结果 358例患者中,良性肿瘤患者258例(72.07%),恶性肿瘤患者100例(27.93%),中转开腹有8例(2.23%)。术后出血二次手术10例(2.79%)。胰体尾良性肿瘤手术保脾率为83.81%。结论机器人辅助下各部位的胰腺良、恶性性微创手术都是安全、可行、有效的,对于提高胰体尾良性肿瘤的保脾率有着显著的优势,有利于控制术中出血和增加术者的操作信心。无论在减少患者术中暴露,还是提高医务人员工作效率方面都有独特的价值。机器人辅助胰腺微创手术对于医患双方都是双赢的。
Objective To discuss the benefits from the robotic assisted minimally invasive pancreatic surgery for both doctors and patients. Methods Review the clinical data summary of the 358 patients,underwent robotic assisted minimally invasive pancreatic surgery in our hospital( pancreaticoduodenectomy in 105 cases,mid-pancreatectomy in 61 cases,distal pancreatectomy in 145 cases,Beger's surgery in 18 cases and enuclearation in 29 cases). Explore the diversities in the operation method and the type of the digestive reconstruction according to the tumors in different locations of the pancreas. Further integrate the patients clinical data( age,gender,operative duration,intraoperative blood lose,postoperative hospital stay and complications),in order to reflect the value of the robotic surgical system in minimally invasive pancreatic surgery. Results Among these 358 patients,258 cases were benign( 72. 07%),however other 100 cases were malignant( 27. 93%). 8 cases( 2. 23%) were convert to laparotomy. Reoperation were needed due to bleeding in 10 cases( 2. 79%). The spleen-preserving rate was 83. 81% in benign distal pancreatic tumors. Conclusions The robotic system assisted minimal invasive surgery is safe,feasible and curative in various pancreatic tumors,benign and malignant. It shows significant advantages in improving the spleen-preserving rate in benign distal pancreatic tumors,as well as controlling the intaroperation bleeding and increasing the performer's confidence. Also,we find it unique values whether in reducing the patients' intraoperative exposure,or saving the medical and human resources. The Robot-assisted minimally invasive pancreatic surgery is a winwin for both doctors and patients.
Objective To discuss the benefits from the robotic assisted minimally invasive pancreatic surgery for both doctors and patients. Methods Review the clinical data summary of the 358 patients,underwent robotic assisted minimally invasive pancreatic surgery in our hospital( pancreaticoduodenectomy in 105 cases,mid-pancreatectomy in 61 cases,distal pancreatectomy in 145 cases,Beger's surgery in 18 cases and enuclearation in 29 cases). Explore the diversities in the operation method and the type of the digestive reconstruction according to the tumors in different locations of the pancreas. Further integrate the patients clinical data( age,gender,operative duration,intraoperative blood lose,postoperative hospital stay and complications),in order to reflect the value of the robotic surgical system in minimally invasive pancreatic surgery. Results Among these 358 patients,258 cases were benign( 72. 07%),however other 100 cases were malignant( 27. 93%). 8 cases( 2. 23%) were convert to laparotomy. Reoperation were needed due to bleeding in 10 cases( 2. 79%). The spleen-preserving rate was 83. 81% in benign distal pancreatic tumors. Conclusions The robotic system assisted minimal invasive surgery is safe,feasible and curative in various pancreatic tumors,benign and malignant. It shows significant advantages in improving the spleen-preserving rate in benign distal pancreatic tumors,as well as controlling the intaroperation bleeding and increasing the performer's confidence. Also,we find it unique values whether in reducing the patients' intraoperative exposure,or saving the medical and human resources. The Robot-assisted minimally invasive pancreatic surgery is a winwin for both doctors and patients.
引文
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2 Giulianoti PC,Corati A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital.Arch Surg,2003,138(7):777-784.
3 韩波,邓侠兴,梁赟,等.机器人外科手术系统辅助下治疗胰腺疾病的临床疗效.上海医学,2011,34(1):12-14
4 沈柏用,刘钦,邓侠兴,等.达芬奇机器人手术系统行胰十二指肠切除术的临床疗效.中华消化外科杂志,2012,11(1):79-81.
5 Cheng K,Shen B Y,Peng C H,et al.Initial experiences in robotassisted middle-pancreatectomy.HPB.2013,15(4):315-321.
6 沈柏用,詹茜,邓侠兴,等.机器人手术系统在胰腺中段切除术中的应用.腹腔镜外科杂志,2012,17(7):481-484.
7 詹茜,彭承宏,邓侠兴,等.微创胰体尾切除术:机器人系统的优势.中华普通外科杂志,2013,28(5):337-341.
8 Peng C H,Shen B Y,Deng X X,et al.Early experience for the robotic duodenum preserving pancreatic head resection.World J Surg.2012,36(5):1136-1141.
9 韩波,沈柏用,邓侠兴,等.机器人辅助保留十二指肠胰头切除术四例报告.中华普通外科杂志,2011,26(8):691-692.
10 詹茜,邓侠兴,韩波,等.机器人辅助胰腺手术:附33例报告.中国微创外科杂志,2012,12(9):769-773.
11 Zhan Q,Deng X X,Han B,et al.Robotic-assisted pancreatic resection:a report of 47 cases.Int J Med Robotics Comput Assist Surg,2013,9:44-51.
12 翁原驰,邓侠兴,詹茜,等.机器人手术系统行胰腺癌根治术的疗效分析.外科理论与实践,2014,19(2):112-116.
13 沈艺南,施洋,朱峰锋,等.胰十二指肠切除术胰肠、胰胃两种吻合方式的Meta分析.腹部外科,2014,27(6):
14 杨骥,黄强,林先盛,等.胰十二指肠切除术后胰胃吻合与胰肠吻合比较的荟萃分析.中华肝胆外科杂志,2014,20(8):
15 杨志丰,陆才德.胰胃吻合术临床应用的研究进展.国际外科学杂志,2013,40(5):.
2 Giulianoti PC,Corati A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital.Arch Surg,2003,138(7):777-784.
3 韩波,邓侠兴,梁赟,等.机器人外科手术系统辅助下治疗胰腺疾病的临床疗效.上海医学,2011,34(1):12-14
4 沈柏用,刘钦,邓侠兴,等.达芬奇机器人手术系统行胰十二指肠切除术的临床疗效.中华消化外科杂志,2012,11(1):79-81.
5 Cheng K,Shen B Y,Peng C H,et al.Initial experiences in robotassisted middle-pancreatectomy.HPB.2013,15(4):315-321.
6 沈柏用,詹茜,邓侠兴,等.机器人手术系统在胰腺中段切除术中的应用.腹腔镜外科杂志,2012,17(7):481-484.
7 詹茜,彭承宏,邓侠兴,等.微创胰体尾切除术:机器人系统的优势.中华普通外科杂志,2013,28(5):337-341.
8 Peng C H,Shen B Y,Deng X X,et al.Early experience for the robotic duodenum preserving pancreatic head resection.World J Surg.2012,36(5):1136-1141.
9 韩波,沈柏用,邓侠兴,等.机器人辅助保留十二指肠胰头切除术四例报告.中华普通外科杂志,2011,26(8):691-692.
10 詹茜,邓侠兴,韩波,等.机器人辅助胰腺手术:附33例报告.中国微创外科杂志,2012,12(9):769-773.
11 Zhan Q,Deng X X,Han B,et al.Robotic-assisted pancreatic resection:a report of 47 cases.Int J Med Robotics Comput Assist Surg,2013,9:44-51.
12 翁原驰,邓侠兴,詹茜,等.机器人手术系统行胰腺癌根治术的疗效分析.外科理论与实践,2014,19(2):112-116.
13 沈艺南,施洋,朱峰锋,等.胰十二指肠切除术胰肠、胰胃两种吻合方式的Meta分析.腹部外科,2014,27(6):
14 杨骥,黄强,林先盛,等.胰十二指肠切除术后胰胃吻合与胰肠吻合比较的荟萃分析.中华肝胆外科杂志,2014,20(8):
15 杨志丰,陆才德.胰胃吻合术临床应用的研究进展.国际外科学杂志,2013,40(5):.