基于胃十二指肠重叠法三角吻合的全机器人远端胃癌根治术的临床应用(附2例报告)
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摘要
目的 :探讨基于胃十二指肠重叠法三角吻合的全机器人远端胃癌根治术临床应用的可行性和安全性。方法:回顾性分析2017年11月,2例使用达芬奇Si机器人手术系统,行全机器人远端胃癌根治术病人的临床资料。结果:病例1为33岁女性远端胃癌病人,病例2为77岁男性病人。两者均成功完成全机器人远端胃癌D2淋巴结清扫以及胃十二指肠重叠法三角吻合,手术时间分别为210 min和240 min。术中出血量20 m L和100 m L;淋巴结清扫数目为32枚和24枚。上、下切缘病理检查结果均未见癌残留。术后首次肛门排气时间3.0 d和2.5 d,进食流质时间4 d和5 d,术后住院6 d和8 d。两者均无术后并发症发生。结论 :基于胃十二指肠重叠法三角吻合的全机器人远端胃癌根治术可行且安全,其临床价值有待进一步深入研究。
Objective To investigate the feasibility and safety of totally robotic radical distal gastrectomy for gastric cancer using delta-shaped gastroduodenostomy with overlap method. Methods The clinical data of 2 patients with gastric cancer who underwent totally robotic radical distal gastrectomy using Da Vinci Si robotic surgical system in November2017 were retrospectively analyzed. Results The first case was 33-year-old female with distal gastric cancer, and the second case was 77-year-old male. Both successfully underwent totally robotic radical distal gastrectomy with D2 lymphadenectomy and delta-shaped gastroduodenostomy using overlap method. Total operating time was 210 min and 240 min with the intraoperative blood loss of 20 mL and 100 mL, the harvested lymph nodes of 32 and 24, respectively. Both had cancer-free resection margin pathologically. The first flatus passage time was 3.0 d and 2.5 d postoperatively with the liquid food for 4 d and 5 d, respectively. Postoperative hospital stay was 6 d and 8 d, respectively. No postoperative complication was found in two cases. Conclusions Totally robotic radical distal gastrectomy for gastric cancer with deltashaped gastroduodenostomy using overlap method is feasible and safe. The further study is needed for the clinical value.
Objective To investigate the feasibility and safety of totally robotic radical distal gastrectomy for gastric cancer using delta-shaped gastroduodenostomy with overlap method. Methods The clinical data of 2 patients with gastric cancer who underwent totally robotic radical distal gastrectomy using Da Vinci Si robotic surgical system in November2017 were retrospectively analyzed. Results The first case was 33-year-old female with distal gastric cancer, and the second case was 77-year-old male. Both successfully underwent totally robotic radical distal gastrectomy with D2 lymphadenectomy and delta-shaped gastroduodenostomy using overlap method. Total operating time was 210 min and 240 min with the intraoperative blood loss of 20 mL and 100 mL, the harvested lymph nodes of 32 and 24, respectively. Both had cancer-free resection margin pathologically. The first flatus passage time was 3.0 d and 2.5 d postoperatively with the liquid food for 4 d and 5 d, respectively. Postoperative hospital stay was 6 d and 8 d, respectively. No postoperative complication was found in two cases. Conclusions Totally robotic radical distal gastrectomy for gastric cancer with deltashaped gastroduodenostomy using overlap method is feasible and safe. The further study is needed for the clinical value.
引文
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[14]严超,燕敏,朱正伦,等.胃十二指肠三角吻合术应用于胃癌全腹腔镜下远端胃切除术的可行性研究[J].中华胃肠外科杂志,2014,17(5):438-443.
[15]Song HM,Lee SL,Hur H,et al.Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy[J].J Gastric Cancer,2010,10(2):69-74.
[16]Byun C,Cui LH,Son SY,et al.Linear-shaped gastroduodenostomy(LSGD):safe and feasible technique of intracorporeal BillrothⅠanastomosis[J].Surg Endosc,2016,30(10):4505-4514.
[2]Obama K,Kim YM,Kang DR,et al.Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy[J].Gastric Cancer,2017 Jun 21.doi:10.1007/s10120-017-0740-7.[Epub ahead of print]
[3]刘江,阮虎,赵坤,等.达芬奇机器人与腹腔镜行胃癌根治术的对照研究[J].中华胃肠外科杂志,2014,17(5):461-464.
[4]Wang G,Jiang Z,Zhao J,et al.Assessing the safety and efficacy 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.
[5]Chen K,Pan Y,Zhang B,et al.Robotic versus laparoscopic Gastrectomy for gastric cancer:a systematic review and updated meta-analysis[J].BMC Surg,2017,17(1):93.
[6]Kim HI,Han SU,Yang HK,et al.Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma[J].Ann Surg,2016,263(1):103-109.
[7]Park JM,Kim HI,Han SU,et al.Who may benefit from robotic gastrectomy?:A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy[J].Eur J Surg Oncol,2016,42(12):1944-1949.
[8]Kim YW,Reim D,Park JY,et al.Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer[J].Surg Endosc,2016,30(4):1547-1552.
[9]Suda K,Man-I M,Ishida Y,et al.Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach:a single institutional retrospective comparative cohort study[J].Surg Endosc,2015,29(3):673-685.
[10]Seo HS,Shim JH,Jeon HM,et al.Postoperative pancreatic fistula after robot distal gastrectomy[J].J Surg Res,2015,194(2):361-366.
[11]Hur H,Kim JY,Cho YK,et al.Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer[J].J Laparoendosc Adv Surg Tech A,2010,20(8):693-697.
[12]Li C.Numerical investigation of a hybrid wave absorption method in 3D numerical wave tank[J].Comput Model Engin Sci,2015,107(2):125-153.
[13]Kikuchi K,Suda K,Nakauchi M,et al.Delta-shaped anastomosis in totally robotic BillrothⅠgastrectomy:technical aspects and short-term outcomes[J].Asian J Endosc Surg,2016,9(4):250-257.
[14]严超,燕敏,朱正伦,等.胃十二指肠三角吻合术应用于胃癌全腹腔镜下远端胃切除术的可行性研究[J].中华胃肠外科杂志,2014,17(5):438-443.
[15]Song HM,Lee SL,Hur H,et al.Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy[J].J Gastric Cancer,2010,10(2):69-74.
[16]Byun C,Cui LH,Son SY,et al.Linear-shaped gastroduodenostomy(LSGD):safe and feasible technique of intracorporeal BillrothⅠanastomosis[J].Surg Endosc,2016,30(10):4505-4514.