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《中华消化外科杂志》2017年8月第16卷第8期论著·新技术

达芬奇机器人手术系统单孔胃癌根治术的临床疗效

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引用本文:
郝迎学,刘春阳,李平昂,等.达芬奇机器人手术系统单孔胃癌根治术的临床疗效[J].中华消化外科杂志,2017,16(8):808-812.DOI:10.3760/cma.j.issn.1673-9752.2017.08.010.
【摘要】

目的:探讨达芬奇机器人手术系统单孔胃癌根治术的临床疗效。
方法:采用回顾性描述性研究方法。收集2017年6月第三军医大学西南医院收治的国内首例行达芬奇机器人手术系统单孔胃癌根治术患者的临床资料。患者行达芬奇机器人手术系统单孔根治性远端胃大部切除+D2淋巴结清扫+ Billroth Ⅱ式吻合术。观察指标:(1)术中及术后情况。(2)随访及生存情况。采用门诊和电话方式进行随访,了解患者术后生存情况。随访时间截至2017年7月。
结果:(1)术中及术后情况:患者成功行达芬奇机器人手术系统单孔根治性远端胃大部切除术。手术时间为303 min,术中出血量为100 mL,无术中并发症发生。肿瘤近切缘距离为5 cm,远切缘距离为6 cm。淋巴结清扫数目为51枚。腹部切口长度为3 cm。术后胃管拔除时间为17 h,并进少量流质食物,术后首次下床活动时间为24 h,术后胃肠功能恢复时间为 36 h,术后腹腔引流管拔除时间为36 h,术后疼痛评分为3分。无术后并发症发生。术后病理学检查:肿瘤侵及深肌层,第3组两枚淋巴结阳性,远、近切缘均为阴性,病理学分期为pT2N1M0期(Ⅱa期)。患者术后住院时间为6 d。(2)随访及生存情况:患者术后随访1个月,生存良好。
结论:达芬奇机器人手术系统单孔胃癌根治术安全可行,近期疗效较好。

【Abstract】

Objective:To explore the clinical efficacy of singleport Da Vinci robotic surgical system in the radical gastrectomy of gastric cancer.
Methods:The retrospective descriptive study was conducted. The clinical data of the first patient in China who underwent singleport radical gastrectomy of gastric cancer using Da Vinci robotic surgical system in the Southwest Hospital of the Third Military Medical University in June 2017 were collected. Patient underwent radical gastrectomy of gastric cancer using singleport Da Vinci robotic surgical system+D2 lymph node dissection + Billroth II anastomosis. Observation indicators: (1) intra and postoperative situations; (2) followup and patients′ survival. Followup using outpatient examination and telephone interview was performed to detect the patients′ postoperative survival up to July 2017.
Results:(1) Intra and postoperative situations: patient underwent radical distal subtotal gastrectomy of gastric cancer using singleport Da Vinci robotic surgical system. Operation time and volume of intraoperative blood loss were respectively 303 minutes and 100 mL. There was no intraoperative complication. The distances from tumor to proximal margin and distal margin were 5 cm and 6 cm. Number of lymph node dissected and length of abdominal incision were 51 and 3 cm. Time of gastric tube removal, time for outofbed activity, time of gastrointestinal function recovery, time of drainage tube removal and postoperative pain score were 17 hours, 24 hours, 36 hours, 36 hours and 3, respectively. Patient took a little fluid diet after gastric tube removal. There was no occurrence of postoperative complication. Results of pathological examination showed that tumor invaded deep muscular layer, with 2 positive lymph nodes in No.3 and negative proximal and distal margins. Pathological staging was pT2N1M0 (Ⅱa staging). Duration of hospital stay was 6 days. (2) Followup and patients′ survival: patient was followed up for 1 month, with a good survival.
Conclusion:The singleport Da Vinci robotic surgical system is safe and feasible in the radical gastrectomy of gastric cancer, with good shortterm outcomes.

DOI:10.3760/cma.j.issn.1673-9752.2017.08.010
基金项目:第三军医大学西南医院临床新技术重点项目(SWH2016YSCXZD-08、SWH2014LC24)
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