中国实用外科杂志

中国实用外科杂志

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机器人手术系统与腹腔镜联合应用治疗直肠癌52例报告

张    成，高广荣，李    达，单永琪，吕    赤，李    瑾，蒋会勇，张雪峰   

  1. 沈阳军区总医院普通外科，辽宁沈阳 110840
  • 出版日期:2016-11-01 发布日期:2016-10-27

  • Online:2016-11-01 Published:2016-10-27

摘要：

目的    探讨机器人联合腹腔镜行直肠癌根治手术的可行性及优势。方法    回顾性分析2011年5月至2016年5月沈阳军区总医院行机器人联合腹腔镜手术治疗的52例直肠癌病人的临床资料，其中有开放手术史者35例，需游离结肠脾曲者11例，联合肝脏局部切除6例。结果    52例病人均顺利完成机器人联合腹腔镜手术。手术时间为（188.6±41.5）min，术中出血（34.3±11.7）mL。未行术前新辅助放化疗的病人淋巴结清扫数为（15.4 ±4.1）枚，行术前新辅助放化疗的病人为（11.2±2.8）枚。直肠远切缘和环周切缘均阴性。TNM分期：Ⅰ期1例，Ⅱ期6例，Ⅲ期39例，Ⅳ期6例。术后病人排气时间为（2.0±0.5）d，拔除尿管时间为（3.0±0.6）d，术后住院时间为（9.0±2.8）d。术后发生肠梗阻1例，无围手术期出血和吻合口瘘发生。结论    机器人手术系统联合腹腔镜用于直肠癌手术治疗安全、可行，尤其适用于需广泛腹腔操作的病人。

关键词: 机器人手术系统, 腹腔镜, 直肠肿瘤

Abstract:

Clinical efficacy of hybrid method combined traditional laparoscope with robotic surgical system on rectal neoplasms        ZHANG Cheng，GAO Guang-rong，LI Da，et al. Department of General Surgery，General Hospital of Shenyang Military Area Command，Shenyang 110840，China
Corresponding author：ZHANG Xue-feng，E-mail:cz1791@126.com
Abstract    Objective    To assess the feasibility and possible benefits of a hybrid surgical technique combined traditional laparoscope with robotic surgical system in rectal neoplasms patients. Methods    The clinical data of 52 cases underwent hybrid method combined traditional laparoscope with robotic surgical system for rectal neoplasms radical operation from May 2011 to May 2016 in General Hospital of Shenyang Military Area Command were analyzed retrospectively，in which 35 had laparotomy history，11 required splenic flexure mobilization，and 6 needed combined liver resection. Results    All the 52 cases underwent operation successfully. The average operative time was （188.6±41.5）min. The average blood loss was （34.3±11.7）mL. The mean numbers of harvested lymph nodes with and without chemoradiation were （11.2 ±2.8） and （15.4 ±4.1）. Distal margin and CRM were negative. TNM stage:1 case of stage Ⅰ，6 cases of stage Ⅱ，39 cases of stage Ⅲ，6 cases of stage Ⅳ. Passage of first flatus was （2.0±0.5）d. The time to remove a urinary catheter was （3.0 ±0.6）d. The postoperative hospital stay was （9.0±2.8）d. Except for intestinal obstruction（n=1），no perioperative complications including anastomotic leakage and hemorrhage were present. Conclusion    The hybrid approach combined robotic surgical system and laparoscope is a safe and feasible technique for rectal neoplasms radical operation，which may be viable option to patients needing extensive abdominal operation.

Key words: robotic surgical system, laparoscopy, rectal neoplasms