达芬奇机器人行妇科手术151例临床分析
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摘要
目的探讨达芬奇机器人手术系统行妇科手术的安全性、可行性及临床应用价值。方法回顾性总结吉林省肿瘤医院于2014年10月至2017年2月实施的151例妇科手术临床资料及治疗效果。结果 151例手术均顺利完成,无中转开腹及更改术式。其中56例全子宫切除、29例宫颈癌、19例子宫内膜癌、18例子宫肌瘤剔除术、18例卵巢瘤核出术、4例乳腺癌去势、2例卵巢瘤单侧附件切除、1例卵巢癌、1例阴道癌、1例子宫次全切除、1例子宫肌瘤+卵巢瘤核出、1例子宫肌瘤剔除+腹膜后肿物切除。手术时间38~280 min,平均(156.9±119.6)min;术中出血量0~120 ml,平均(64.9±53.7)ml;术后肠道功能恢复时间7~54 h,平均(31.4±22.7)h;膀胱功能恢复时间13~356 h,平均(192.7±178.6)h;切除淋巴结15~44枚,平均(28.4±12.7)枚;住院时间89~648 h,平均(196.2±73.4)h。结论达芬奇机器人外科手术系统应用于妇科手术安全可行,尤其是在恶性肿瘤手术优势明显,患者出血少、创伤小、恢复快、安全性高,具有临床应用价值。
Objective To explore the safety,feasibility and clinical value of gynecological surgery in Da Vinci robot system. Methods Retrospective summary of Jilin Provincial Tumor Hospital in Oct. 2014 to Feb. 2017 implementation of 151 cases of gynecological surgery clinical data and treatment. Results 151 patients were successfully completed surgery,no transfer to open and change the operation. 56 cases of hysterectomy,29 cases of cervical cancer,19 cases of endometrial cancer,18 cases of uterine leiomyoma,18 cases of ovarian tumor,4 cases of breast cancer castration,2 cases of unilateral appendiceal ovarian resection,1 case of ovarian cancer,1 case of vaginal cancer,1 case of uterine total resection,1 case of uterine fibroids + ovarian tumor nucleus,1 case of uterine fibroids removed + retroperitoneal tumor resection. The operation time ranged from 38-280 min,the average(156. 9 ± 119. 6) min; intraoperative blood loss was0-120 ml,the average(64. 9 ± 53. 7) ml; postoperative intestinal function recovery time was 7-54 h,the average(31. 4 ± 22. 7) h; bladder function recovery time of 13-356 h,average(192. 7 ± 178. 6) h;lymph node resection from 15-44,the average(28. 4 ± 12. 7); hospitalization time was 89-648 h,the average(196. 2 ± 73. 4) h. Conclusions Da Vinci robotic surgical operating system is safe and feasible for gynecological surgery,especially in the obvious advantages of malignant tumors,patients with less bleeding,less trauma,quick recovery,high safety,with clinical value.
Objective To explore the safety,feasibility and clinical value of gynecological surgery in Da Vinci robot system. Methods Retrospective summary of Jilin Provincial Tumor Hospital in Oct. 2014 to Feb. 2017 implementation of 151 cases of gynecological surgery clinical data and treatment. Results 151 patients were successfully completed surgery,no transfer to open and change the operation. 56 cases of hysterectomy,29 cases of cervical cancer,19 cases of endometrial cancer,18 cases of uterine leiomyoma,18 cases of ovarian tumor,4 cases of breast cancer castration,2 cases of unilateral appendiceal ovarian resection,1 case of ovarian cancer,1 case of vaginal cancer,1 case of uterine total resection,1 case of uterine fibroids + ovarian tumor nucleus,1 case of uterine fibroids removed + retroperitoneal tumor resection. The operation time ranged from 38-280 min,the average(156. 9 ± 119. 6) min; intraoperative blood loss was0-120 ml,the average(64. 9 ± 53. 7) ml; postoperative intestinal function recovery time was 7-54 h,the average(31. 4 ± 22. 7) h; bladder function recovery time of 13-356 h,average(192. 7 ± 178. 6) h;lymph node resection from 15-44,the average(28. 4 ± 12. 7); hospitalization time was 89-648 h,the average(196. 2 ± 73. 4) h. Conclusions Da Vinci robotic surgical operating system is safe and feasible for gynecological surgery,especially in the obvious advantages of malignant tumors,patients with less bleeding,less trauma,quick recovery,high safety,with clinical value.
引文
1刘忠宇,李秀丽,李卫平,等.达芬奇机器人手术系统在妇科肿瘤的临床应用[J/CD].中华腔镜外科杂志(电子版),2014,7(6):52-55.
2 丁晓萍,刘蕊,刘媛媛,达芬奇机器人辅助卵巢子宫内膜异位囊肿手术8例临床分析[J].中国妇产科临床杂志,2010,11(6):447-448.
3 Diaz-Arrastie C,Jumalov C,Gomez G,et al.Laparoscopic hysterectomy using a computer-enhanced surgical robot[J].Surg Endose,2002,16(9):1271-1273.
4 Payne TN,Dauterive L.A comparison of total laparoscop-ic hysterectomy to robotically assisted hysterectomy:surgical outcomes in a community practice[J].J Minim In vasive Gynecol,2008,15(3):286-291.
5 Vlaovic PD,Sargent ER,Boker JR,et al.Immediate impact of an intensive one week laparoscopy training program on laparoscopic skills among postgraduate urologists[J].JSLS,2008,12(1):1-8.
6 丁玉兰,赵卫东.机器人手术在妇科恶性肿瘤手术治疗中的应用[J].国际妇产科学杂志,2011,2(38):56-59.
7 Sert B,Abeler V.Robotic radical hysterectomy in early-stage cervical carcinoma patients,comparing results with total laparoscopic radical hysterectomy cases.the future is now[J].International Journal of Medical Robotics&Computer Assisted Surgery,2007,3(3):224-228.
8 Ngo C,Cornou C,Rossi L,et al.Evidence for the use of robotically assisted surgery in gynaecologic cancers[J].Current Opinion in Oncology,2016,28(5):398-403.
9 Minig L,Zanagnolo V,Cárdenas-Rebollo JM,et al.Feasibility of robotic radical hysterectomy after neoadjuvant chemotherapy in women with locally advanced cervical cancer[J].European Journal of Surgical Oncology,2016,42(9):1372-1377.
10 Corrado G,Cutillo G,Pomati G,et al.Surgical and oncological utcome of robotic surgery compared to laparoscopic and abdominalsurgery in the management of endometrial cancer[J].Eur J urg Oncol,2015,41(8):1074-1081.
11 叶明侠,俞凌,范文生,等.机器人系统在早期卵巢癌治疗的临床应用分析[J].中华医学杂志,2017,97(13):982-985.
12 Johansen G,Lonnerfors C,Falconer H,et al.Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer[J].Gynecol Oncol,2016,141(1):160-165.
13 Querleu D,Leblanc E.Laparoscopic infrarenal paraaortic lymph node dissection for restaging of carcinoma of the ovary or fallopian tube[J].Cancer,1994,73(5):1467-1471.
14 朱晓艳,王海琳.机器人辅助腹腔镜手术在妇科领域中的应用进展[J].现代妇产科进展,2012,10(21):802-804.
15 孙小单,袁勇.机器人及传统腹腔镜全子宫切除术的临床比较[J/CD].中华腔镜外科杂志(电子版),2015,8(2):18-21.
16 Shemer J.Laparascopic surgery and robotic-guided surgery[J].Harefuah,2009,148(3):169-170,210.
17 Bedient CE,Magrina JF,Noble BN,et al.Comparison of robotic and laparoscopic myomectomy[J].Am J Obstet Gynecol,2009,201(6):566-567.
2 丁晓萍,刘蕊,刘媛媛,达芬奇机器人辅助卵巢子宫内膜异位囊肿手术8例临床分析[J].中国妇产科临床杂志,2010,11(6):447-448.
3 Diaz-Arrastie C,Jumalov C,Gomez G,et al.Laparoscopic hysterectomy using a computer-enhanced surgical robot[J].Surg Endose,2002,16(9):1271-1273.
4 Payne TN,Dauterive L.A comparison of total laparoscop-ic hysterectomy to robotically assisted hysterectomy:surgical outcomes in a community practice[J].J Minim In vasive Gynecol,2008,15(3):286-291.
5 Vlaovic PD,Sargent ER,Boker JR,et al.Immediate impact of an intensive one week laparoscopy training program on laparoscopic skills among postgraduate urologists[J].JSLS,2008,12(1):1-8.
6 丁玉兰,赵卫东.机器人手术在妇科恶性肿瘤手术治疗中的应用[J].国际妇产科学杂志,2011,2(38):56-59.
7 Sert B,Abeler V.Robotic radical hysterectomy in early-stage cervical carcinoma patients,comparing results with total laparoscopic radical hysterectomy cases.the future is now[J].International Journal of Medical Robotics&Computer Assisted Surgery,2007,3(3):224-228.
8 Ngo C,Cornou C,Rossi L,et al.Evidence for the use of robotically assisted surgery in gynaecologic cancers[J].Current Opinion in Oncology,2016,28(5):398-403.
9 Minig L,Zanagnolo V,Cárdenas-Rebollo JM,et al.Feasibility of robotic radical hysterectomy after neoadjuvant chemotherapy in women with locally advanced cervical cancer[J].European Journal of Surgical Oncology,2016,42(9):1372-1377.
10 Corrado G,Cutillo G,Pomati G,et al.Surgical and oncological utcome of robotic surgery compared to laparoscopic and abdominalsurgery in the management of endometrial cancer[J].Eur J urg Oncol,2015,41(8):1074-1081.
11 叶明侠,俞凌,范文生,等.机器人系统在早期卵巢癌治疗的临床应用分析[J].中华医学杂志,2017,97(13):982-985.
12 Johansen G,Lonnerfors C,Falconer H,et al.Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer[J].Gynecol Oncol,2016,141(1):160-165.
13 Querleu D,Leblanc E.Laparoscopic infrarenal paraaortic lymph node dissection for restaging of carcinoma of the ovary or fallopian tube[J].Cancer,1994,73(5):1467-1471.
14 朱晓艳,王海琳.机器人辅助腹腔镜手术在妇科领域中的应用进展[J].现代妇产科进展,2012,10(21):802-804.
15 孙小单,袁勇.机器人及传统腹腔镜全子宫切除术的临床比较[J/CD].中华腔镜外科杂志(电子版),2015,8(2):18-21.
16 Shemer J.Laparascopic surgery and robotic-guided surgery[J].Harefuah,2009,148(3):169-170,210.
17 Bedient CE,Magrina JF,Noble BN,et al.Comparison of robotic and laparoscopic myomectomy[J].Am J Obstet Gynecol,2009,201(6):566-567.