目的總結“達芬奇”機器人手術系統(tǒng)進行普通外科手術180例的臨床經(jīng)驗。 方法我院在2009年1月至2010年10月應用“達芬奇”機器人手術系統(tǒng)進行了180例普外科手術,對病例的分布、手術過程以及術后恢復情況進行總結。 結果171例患者在全機器人下完成手術,9例中轉開腹手助完成,中轉率為5.0%(9/180)。行肝門部手術63例,包括肝門部膽管癌手術36例,膽囊癌手術10例,復雜肝內膽管結石手術12例和醫(yī)源性膽管損傷手術5例; 胰腺手術44例,包括胰十二指腸切除術16例,胰體尾切除術6例,胰腺中段切除術1例,胰腺假性囊腫空腸吻合術1例和姑息性手術20例; 肝臟手術19例; 胃腸手術12例; 其他手術42例,包括膽總管探查取石術、腹膜后淋巴結清掃、脾臟切除術等。10例梗阻性化膿性膽管炎患者均在全機器人下順利完成急診手術,術后感染癥狀得以控制,休克很快糾正,無圍手術期死亡病例。12例患者術后出現(xiàn)并發(fā)癥,總并發(fā)癥發(fā)生率為6.7%(12/180); 死亡2例,死亡率為1.1%(2/180)。 結論“達芬奇”機器人手術系統(tǒng)可以獨立完成各種類型普通外科手術,尤其是復雜疑難的肝膽胰手術,拓展了腹腔鏡外科的手術適應證,推動了微創(chuàng)外科的進程。
引用本文: 周寧新,陳軍周,劉全達,張效東,張濤,陳澤峰. “達芬奇”機器人普通外科手術180例: 中國單中心報道. 中國普外基礎與臨床雜志, 2011, 18(7): 698-704. doi: 復制
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- 1. Lanfranco AR, Castellanos AE, Desai JP, et al. Robotic surgery: a current perspective[J]. Ann Surg, 2004, 239(1): 1421.
- 2. Kaushik D, High R, Clark CJ, et al. Malfunction of the Da vinci robotic system during robotassisted laparoscopic prostatectomy: an international survey [J]. J Endourol, 2010, 24(4): 571575.
- 3. 鄭樹國, 李建偉, 陳健, 等. 應用達芬奇機器人手術系統(tǒng)治療壺腹部癌 [J]. 中華消化外科雜志, 2010, 9(2): 112113..
- 4. 紀文斌, 趙之明, 王宏光, 等. 達芬奇機器人手術系統(tǒng)在肝膽胰外科的應用 [J]. 中華消化外科雜志, 2010, 9(2): 109111..
- 5. Narula VK, Mikami DJ, Melvin WS. Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach [J]. Pancreas, 2010, 39(2): 160164.
- 6. 陳軍周, 周寧新, 劉全達, 等. 達芬奇機器人手術系統(tǒng)再手術入路的選擇 [J]. 中華消化外科雜志, 2010, 9(2): 105108..
- 7. 余佩武, 錢鋒, 曾冬竹, 等. 達芬奇機器人手術系統(tǒng)胃癌根治術五例報告 [J]. 中華外科雜志, 2010, 48(20): 15921594..
- 8. 黃志強. 3D時代的肝膽外科: 從“阿童木”到“阿凡達” [J]. 中華腔鏡外科雜志(電子版), 2010, 3(3): 218220.
- 9. Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery:personal experience in a large community hospital [J]. Arch Surg, 2003, 138(7): 777784.
- 10. 吳繼敏, 汪忠鎬, 季鋒, 等. 腹腔鏡Nisssen胃底折疊術治療胃食管反流病 [J]. 中華普外科雜志, 2009, 18(10): 10551058..
- 11. Khatlani K, Sharma S, Mendoza PJ, et al. The current state of robot assisted radical prostatectomy [J]. Minerva Urol Nefrol, 2010, 62(2): 193201.
- 12. Hwang SH, Park DJ, Jee YS, et al. Actual 3year survival after laparoscopyassisted gastrectomy for gastric cancer [J]. Arch Surg, 2009, 144(6): 559564.
- 13. Shim JH, Song KY, Kim SN, et al. Laparoscopyassisted distal gastrectomy for overweight patients in the asian population[J]. Surg Today, 2009, 39(6): 481486.
- 14. Francescutti V, Choy I, Biertho L, et al. Gastrectomy and esophagogastrectomy for proximal and distal gastric lesions: a comparison of open and laparoscopic procedures [J]. Surg Innov, 2009, 16(2): 134139.
- 15. Strong VE, Devaud N, Allen PJ, et al. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a casecontrol study [J]. Ann Surg Oncol, 2009, 16(6): 15071513.
- 16. 余佩武. 腹腔鏡胃癌根治術的原則與評價 [J]. 中國普外基礎與臨床雜志, 2009, 16(1): 15..
- 17. 周寧新, 陳軍周, 劉全達, 等. 達芬奇機器人手術系統(tǒng)和開腹胰十二指腸切除術的比較 [J]. 中華消化外科雜志, 2010, 9(2): 101104..
- 18. Huettner F, Dynda D, Ryan M, et al. Roboticassisted minimally invasive surgery; a useful tool in resident training—the peoria experience, 20022009 [J]. Int J Med Robot, 2010, 6(4): 386393.
- 19. Jayaraman S, Davies W, Schlachta CM. Getting started with robotics in general surgery with cholecystectomy:the canadian experience [J]. Can J Surg, 2009, 52(5): 374378.
- 20. Hashizume M, Tsugawa K. Robotic surgery and cancer: the present state, problems and future vision [J]. Jpn J Clin Oncol, 2004, 34(5): 227237.
- 21. Camarillo DB, Krummel TM, Salisbury JK. Robotic technology in surgery: past, present, and future [J]. Am J Surg, 2004, 188(4A Suppl): 2S15S.
- 22. 鄭民華. 中國腹腔鏡外科的現(xiàn)狀與進展 [J]. 中華腔鏡外科雜志(電子版), 2010, 3(1): 16..
- 23. Chen CC, Falcone T. Robotic gynecologic surgery: past, present, and future [J]. Clin Obstet Gynecol, 2009, 52(3): 335343.