中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (01): 44-46.

• 论著 • 上一篇    下一篇

Da Vinci机器人辅助下肝门部胆管癌手术治疗术式选择与改进

周宁新，刘全达，陈军周，张效东，段伟宏，王知非   

  1. 第二炮兵总医院肝胆胃肠病研究所，北京100088
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-01-12 发布日期:2010-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2010-01-12 Published:2010-01-12

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摘要：

目的 总结da Vinci机器人手术系统在肝门部胆管癌切除手术中的早期应用经验。方法 复习第二炮兵总医院2009年1~6月57例机器人辅助的肝胆胰手术病例临床资料，介绍其中6例肝门部胆管癌切除术的临床效果。结果 6例中，男5例，女1例；年龄（60±8）岁。Bismuth分型I型1例，Ⅲb型2例， Ⅳ型3例（1例术前行PTCD 1个月）。Bismuth I型病人实施机器人辅助下根治性胆管癌切除、胆肠吻合术；Ⅲb型病人1例实施左半肝切除术，1例实施肝门部胆管癌切除、胆管外引流术； Bismuth Ⅳ型病人均实施机器人辅助下胆管癌切除、间置胆囊胆道重建术。术后1例进食后发生不全性肠梗阻，禁食1d后缓解；未发生胆漏、腹膜炎等其他并发症。中位随访时间3个月，未见明确肿瘤复发征象。结论 da Vinci机器人手术系统实施肝门部胆管癌切除术完全可行，具有手术视觉更扩大清晰，深度操作更确切容易，解剖性探查精细灵巧，手术方案可进可退，创伤小恢复快等优点。机器人辅助下肝门部胆管癌手术对病人的远期生存的影响，仍须进一步观察。

关键词: da Vinci手术系统, 机器人外科 , 肝门部胆管癌

Abstract:

da Vinci Robot-Assisted resection for hilar cholangiocarcinoma: preliminary experience from china ZHOU Ning-xin, LIU Quanda, CHEN Jun-zhou,et al. Institute of Hepatobiliary & Gastrointestinal Diseases, ERPAO General Hospital, Beijing 100088, China Corresponding author:ZHOU Ning-xin,E-mail:zhounx301@163.com Abstract Objective To summarize the initial experience of application of da Vinci Surgical System for resection of hilar cholangiocarcinoma.Methods Fifty-seven patients undergone robot-assisted hepatobiliopancreatic (HBP) operations from January to June 2009 were reviewed, and the clinical results of the 6 cases receiving resection of hilar cholangiocarcinoma were introduced.Results The Bismuth classification of 6 patients (5 male, 1 female, with average ages of 60±8 years old) with hilar cholangiocarcinoma was: 1 of type I, 2 of type IIIb, 3 of type Ⅳ. One patient performed PTC drainage 1-month ago. The robot-assisted surgical procedures included: radical resection of hilar cholangiocarcinoma and Roux-en-Y hepatojejunostomy for 1 patient with Bismuth type I, left hemihepatectomy for 1 patient with Bismuth type IIIb, resection of hilar cholangiocarcinoma and external drainage of secondary biliary radicals for 1 patient with Bismuth type IIIb, and resection of hilar cholangiocarcinoma and biliary reconstruction with gallbladder bridging for 3 patients with Bismuth type Ⅳ. All patients recovered uneventfully. Incomplete intestinal obstruction was occurred in one patient after overfeeding on fifth postoperative day, which was relieved by one-day fasting. No complications such as biliary leak, peritonitis occurred. No signs of tumor recurrence were revealed during a median 3-month follow-up period.Conclusion Robot-assisted resection for hilar cholangiocarcinoma is feasibility and safe. The robotic surgical system has superiority such as precision, dexterity while performing the operation, and faster recovery for patients, which offers the future trend for HBP minimally invasive surgery. However, further study is mandatory to clarify the longterm results following robot-assisted resection for hilar cholangiocarcinoma.

Key words: da Vinci surgical system, robotic surgery, hilar cholangiocarcinoma , minimally invasive surgery