机器人辅助肝切除术:附71例报告
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摘要
目的探讨达芬奇机器人辅助肝切除术的安全性及临床应用价值。方法回顾性分析2015年4月至2018年12月在中山大学附属第一医院接受达芬奇机器人辅助肝切除术的71例患者临床资料。患者均签署知情同意书,符合医学伦理学要求。其中男48例,女23例;年龄18～76岁,中位年龄56岁。肝脏恶性肿瘤54例,肝脏良性肿物4例,肝门部胆管癌1例,肝囊肿1例,肝内胆管结石10例,先天性胆管囊性扩张症Ⅴ型1例。分析其临床转归。结果 90%(64/71)患者顺利完成机器人辅助肝切除术,中转开腹率10%(7/71)。其中行左半肝切除术15例,左半肝联合尾状叶切除2例,右半肝切除术7例,肝中叶切除1例,2个及以上肝段切除术28例,1个肝段或肿瘤局部切除术18例。机器人手术中位时间为285(196,374)min,术中出血量为100(50,300)ml。术后病理检查示R0切除率100%。术后并发症发生率11%(8/71),其中腹腔感染4例,泌尿系感染1例,深静脉血栓1例,肝功能不全1例,脑梗塞1例,均经保守治疗后治愈。无围手术期死亡。术后住院时间8(7,11)d。结论与传统手术相比,机器人辅助肝切除术具有解剖更精细、操作更灵活的优势,是一种安全、可行的微创手术。
Objective To explore the safety and application value of da Vinci robot-assisted hepatectomy in clinical practice. Methods Clinical data of 71 patients undergoing da Vinci robot-assisted hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from April 2015 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 48 patients were male and 23 female, aged 18-76 years with a median age of 56 years. 54 cases were diagnosed with malignant liver tumors, 4 cases of benign liver tumors, 1 case of hilar cholangiocarcinoma, 1 case of liver cyst, 10 cases of hepatolithiasis and 1 case of typeⅤ congenital choledochal cyst. The clinical outcomes of patients were analyzed. Results Robot-assisted hepatectomy was successfully performed in 90%(64/71) of the patients. The conversion rate to open surgery was 10%(7/71). Among them, 15 cases underwent left hemihepatectomy, 2 cases of left hemihepatectomy combined with caudate lobectomy, 7 cases of right hemihepatectomy, 1 case of mesohepatectomy. 28 cases received resection of 2 or more segments. 18 cases received local resection of tumor or resection of 1 segment.The median time of robot-assisted surgery was 285(196, 374) min, and the intraoperative blood loss was100(50, 300) ml. Postoperative pathological examination revealed that the R0 resection rate was 100%. The incidence of postoperative complications was 11%(8/71), including 4 cases of abdominal infection, 1 case of urinary infection, 1 case of deep venous thrombosis, 1 case of hepatic insufficiency and 1 case of cerebral infarction. All of them were cured after conservative treatments. No perioperative death occurred. The length of postoperative hospital stay was 8(7-11) d. Conclusions Compared with the traditional surgery, robotassisted hepatectomy has the advantages of more accurate anatomical dissection and more flexible operations,which is a safe and feasible minimally invasive surgery.
Objective To explore the safety and application value of da Vinci robot-assisted hepatectomy in clinical practice. Methods Clinical data of 71 patients undergoing da Vinci robot-assisted hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from April 2015 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 48 patients were male and 23 female, aged 18-76 years with a median age of 56 years. 54 cases were diagnosed with malignant liver tumors, 4 cases of benign liver tumors, 1 case of hilar cholangiocarcinoma, 1 case of liver cyst, 10 cases of hepatolithiasis and 1 case of typeⅤ congenital choledochal cyst. The clinical outcomes of patients were analyzed. Results Robot-assisted hepatectomy was successfully performed in 90%(64/71) of the patients. The conversion rate to open surgery was 10%(7/71). Among them, 15 cases underwent left hemihepatectomy, 2 cases of left hemihepatectomy combined with caudate lobectomy, 7 cases of right hemihepatectomy, 1 case of mesohepatectomy. 28 cases received resection of 2 or more segments. 18 cases received local resection of tumor or resection of 1 segment.The median time of robot-assisted surgery was 285(196, 374) min, and the intraoperative blood loss was100(50, 300) ml. Postoperative pathological examination revealed that the R0 resection rate was 100%. The incidence of postoperative complications was 11%(8/71), including 4 cases of abdominal infection, 1 case of urinary infection, 1 case of deep venous thrombosis, 1 case of hepatic insufficiency and 1 case of cerebral infarction. All of them were cured after conservative treatments. No perioperative death occurred. The length of postoperative hospital stay was 8(7-11) d. Conclusions Compared with the traditional surgery, robotassisted hepatectomy has the advantages of more accurate anatomical dissection and more flexible operations,which is a safe and feasible minimally invasive surgery.
引文
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[15]Ocuin LM,Tsung A.Robotic liver resection for malignancy:current status,oncologic outcomes,comparison to laparoscopy,and future applications[J].J Surg Oncol,2015,112(3):295-301.
[16]Hu L,Yao L,Li X,et al.Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms:a meta-analysis of retrospective studies[J].Asian J Surg,2018,41(5):401-416.
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[18]Tsung A,Geller DA,Sukato DC,et al.Robotic versus laparoscopic hepatectomy:a matched comparison[J].Ann Surg,2014,259(3):549-555.
[19]Qiu J,Chen S,Chengyou D.A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms[J].Surg Endosc,2016,30(3):862-875.
[20]Chen PD,Wu CY,Hu RH,et al.Robotic versus open hepatectomy for hepatocellular carcinoma:a matched comparison[J].Ann Surg Oncol,2017,24(4):1021-1028.
[2]Efanov M,Alikhanov R,Tsvirkun V,et al.Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection[J].HPB,2017,19(9):818-824.
[3]Morel P,Jung M,Cornateanu S,et al.Robotic versus open liver resections:a case-matched comparison[J].Int J Med Robot,2017,DOI:10.1002/rcs.1800.
[4]Nota CL,Rinkes IHB,Molenaar IQ,et al.Robot-assisted laparoscopic liver resection:a systematic review and pooled analysis of minor and major hepatectomies[J].HPB,2016,18(2):113-120.
[5]Giulianotti PC,Coratti A,Sbrana F,et al.Robotic liver surgery:results for 70 resections[J].Surgery,2011,149(1):29-39.
[6]殷晓煜.手术治疗先天性胆管扩张症胆肠重建术式探讨[J].中国实用外科杂志,2012,32(3):253-255.
[7]Szold A,Bergamaschi R,Broeders I,et al.European Association of Endoscopic Surgeons(EAES)consensus statement on the use of robotics in general surgery[J].Surg Endosc,2015,29(2):253-288.
[8]Tsilimigras DI,Moris D,Vagios S,et al.Safety and oncologic outcomes of robotic liver resections:a systematic review[J].J Surg Oncol,2018,117(7):1517-1530.
[9]Wakabayashi G,Cherqui D,Geller DA,et al.Recommendations for laparoscopic liver resection:a report from the second international consensus conference held in Morioka[J].Ann Surg,2015,261(4):619-629.
[10]Croner RS,Perrakis A,Hohenberger W,et al.Robotic liver surgery for minor hepatic resection:a comparison with laparoscopic and open standard procedures[J].Langenbecks Arch Surg,2016,401(5):707-714.
[11]Gravetz A,Sucandy I,Wilfong C,et al.Single-institution early experience and learning curve with roboticLiver resections[J].Am Surg,2019,85(1):115-119.
[12]Park EJ,Cho MS,Baek SJ,et al.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer:a comparative study with laparoscopic surgery[J].Ann Surg,2015,261(1):129-137.
[13]Autorino R,Zargar H,Mariano MB,et al.Perioperative outcomes of robotic and laparoscopic simple prostatectomy:a European-American multi-institutional analysis[J].Eur Urol,2015,68(1):86-94.
[14]Yoo HN,Kim TJ,Lee YY,et al.Single-site robotic surgery in gynecologic cancer:a pilot study[J].J Gynecol Oncol,2015,26(1):62-67.
[15]Ocuin LM,Tsung A.Robotic liver resection for malignancy:current status,oncologic outcomes,comparison to laparoscopy,and future applications[J].J Surg Oncol,2015,112(3):295-301.
[16]Hu L,Yao L,Li X,et al.Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms:a meta-analysis of retrospective studies[J].Asian J Surg,2018,41(5):401-416.
[17]Jackson NR,Hauch A,Hu T,et al.The safety and efficacy of approaches to liver resection:a meta-analysis[J].JSLS,2015,19(1):e2014.00186.
[18]Tsung A,Geller DA,Sukato DC,et al.Robotic versus laparoscopic hepatectomy:a matched comparison[J].Ann Surg,2014,259(3):549-555.
[19]Qiu J,Chen S,Chengyou D.A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms[J].Surg Endosc,2016,30(3):862-875.
[20]Chen PD,Wu CY,Hu RH,et al.Robotic versus open hepatectomy for hepatocellular carcinoma:a matched comparison[J].Ann Surg Oncol,2017,24(4):1021-1028.