中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (08): 912-916.DOI: 10.19538/j.cjps.issn1005-2208.2025.08.12

• 论著 • 上一篇    下一篇

机器人辅助肝切除手术技巧与规范化流程研究

杨广超1，李中宇1,2，尹    兵1,2，鲁首男1,2，李林强1，宋    宣1，李梓豪1，孙    备2，姜洪池2，麻    勇1,2   

  1. 1哈尔滨医科大学附属第一医院肝脏微创外科，黑龙江哈尔滨 150001；2黑龙江省肝脾外科教育部重点实验室，黑龙江哈尔滨 150001
  • 出版日期:2025-08-01 发布日期:2025-09-02

  • Online:2025-08-01 Published:2025-09-02

摘要： 目的    总结机器人辅助肝切除手术的临床实践经验，探讨基于精细解剖的手术技巧与规范化操作流程，分析机器人辅助肝切除手术的疗效。方法    回顾性分析2021年7月至2025年7月哈尔滨医科大学附属第一医院行机器人辅助肝切除手术的600例肝占位性病变病人的临床资料，包括手术时间，术中出血量、输血量、中转开放手术情况，术后肝功能、引流管拔除时间、并发症、住院时间以及住院费用等，并总结机器人辅助肝切除手术中精细解剖的应用。结果    恶性肿瘤病人206例，良性疾病病人394例。肝脏良性疾病病人手术时间为130.0（94.0, 165.0）min，术中出血量为50.0（50.0, 100.0）mL；肝脏恶性肿瘤病人手术时间为150.0（100.0, 195.0）min，术中出血量为80.0（50.0, 120.0）mL。所有病人均未中转开放手术，术后肝功能恢复良好。肝脏良性肿瘤病人术后拔除引流管时间为7.0（6.0, 8.0） d、术后住院时间为8.0（7.0, 9.0） d、住院费用为73 590.0（70 900.3, 76 445.5）元。肝脏恶性肿瘤病人术后拔除引流管时间为8.0（6.0, 9.0） d、术后住院时间为9.0（8.0, 10.0） d、住院费用为79 657.0（77 242.5, 82 531.5）元。所有病人并发症Clavien‑Dindo分级Ⅲ级及以上发生率为1.5%，包括术后出血2例、胆漏1例、低白蛋白血症6例，围手术期无病人死亡，术后90 d内病死率为0。结论    基于精细解剖，规范化机器人辅助肝切除手术的手术操作流程能够有效保障手术安全性及效果，具有手术精准度高、创伤小、并发症少等优势。

关键词: 机器人辅助手术, 肝切除手术, 精细解剖, 规范化流程

Abstract: To summarize the clinical experience of robotic-assisted precise hepatectomy, explore the surgical techniques and standardized operational procedures based on precise anatomy, and analyze the efficacy of robotic-assisted hepatectomy. Methods    A retrospective analysis was performed on the clinical data of 600 patients with hepatic space-occupying lesions who underwent robotic-assisted precise hepatectomy at the First Affiliated Hospital of Harbin Medical University from July 2021 to July 2025. Clinical data included operative time, intraoperative blood loss, intraoperative blood transfusion volume, conversion to open surgery, postoperative liver function, postoperative drainage tube removal time, postoperative complications, postoperative hospital stay, and postoperative hospital costs. Additionally, the application of precise anatomy in robotic-assisted precise hepatectomy was summarized. Results    All patients included 206 cases of malignant tumors and 394 cases of benign diseases. For patients with benign diseases, the operative time was 130.0 (94.0, 165.0) min, and the intraoperative blood loss was 50.0 (50.0, 100.0) mL. For patients with malignant liver tumors, the operative time was 150.0 (100.0, 195.0) min, and the intraoperative blood loss was 80.0 (50.0, 120.0) mL. None of the patients required conversion to open surgery, and postoperative liver function recovered well. For patients with benign liver tumors, the postoperative drainage tube removal time was 7.0 (6.0, 8.0) d, the postoperative hospital stay was 8.0 (7.0, 9.0) d, and the hospital cost was 73 590.0 (70 900.3, 76 445.5) yuan. For patients with malignant liver tumors, the postoperative drainage tube removal time was 8.0 (6.0, 9.0) d, the postoperative hospital stay was 9.0 (8.0, 10.0) d, and the hospital cost was 79 657.0 (77 242.5, 82 531.5) yuan. The incidence of Clavien-Dindo grade Ⅲ or higher complications in all patients was 1.5%, including 2 cases of postoperative bleeding, 1 case of biliary leakage, and 6 cases of hypoalbuminemia. There were no perioperative deaths, and the mortality rate within 90 d postoperatively was 0. Conclusion    Under the premise of precise anatomy, standardized surgical procedures for robotic-assisted hepatectomy can effectively ensure surgical safety and efficacy, with advantages such as high precision, minimal invasiveness, and few complications.

Key words: robotic-assisted surgery, hepatectomy, precise dissection, standardized procedures