• 沈陽軍區(qū)總醫(yī)院普通外科(遼寧沈陽 110016);

目的  總結(jié)達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在直腸癌前切除術(shù)中的應(yīng)用體會。
方法  筆者于2011年5月至2012年1月期間應(yīng)用腹腔鏡聯(lián)合達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)實(shí)施了直腸癌前切除術(shù)11例。均采用4孔法;先行腹腔鏡探查,確定具有達(dá)芬奇機(jī)器人手術(shù)的可行性后,再在腹腔鏡引導(dǎo)下放置戳卡,擺放體位,經(jīng)腹壁懸吊乙狀結(jié)腸及子宮;鏡下分離解剖應(yīng)用達(dá)芬奇機(jī)器人手術(shù)系統(tǒng); 直腸的離斷及吻合轉(zhuǎn)在腹腔鏡下完成?;仡櫺苑治鲈?1例患者的臨床資料,并總結(jié)手術(shù)體會。
結(jié)果  11例患者均順利完成手術(shù),均未中轉(zhuǎn)開腹;手術(shù)時間210~330min,平均288.6min;術(shù)中出血量20~100ml,平均40ml;清掃淋巴結(jié)數(shù)量12~21枚/例,平均13.9枚/例;術(shù)后排氣時間18~26h,平均22h;術(shù)后住院時間7~16d,平均11.5d;術(shù)中及術(shù)后均未出現(xiàn)并發(fā)癥;術(shù)后病理學(xué)檢查示切緣均未見癌細(xì)胞殘留。
結(jié)論  應(yīng)用達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)實(shí)施直腸癌前切除術(shù)安全可行,其手術(shù)創(chuàng)傷小,患者術(shù)后恢復(fù)快。

引用本文: 李瑾,張成,蔣會勇,呂赤,呂晨光,郭一君,高廣榮,張雪峰. 應(yīng)用達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)輔助直腸癌前切除術(shù)11例體會. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(12): 1319-1322. doi: 復(fù)制

1. Thiel DD, Winfield HN. Robotics in urology:past, present, and future[J]. J Endourol, 2008, 22(4):825-830.
2. 朱軍, 丁健華, 湯海燕, 等. 腹腔鏡與開腹全直腸系膜切除術(shù)治療中低位直腸癌的臨床對照研究[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(6):636-641.
3. Leong QM, Kim SH. Robot-assisted rectal surgery for malignancy:a review of current literature[J]. Ann Acad Med Singapore, 2011, 40(10):460-466.
4. Kwak JM, Kim SH, Kim J, et al. Robotic vs. laparoscopic resection of rectal cancer:short-term outcomes of a case-control study[J]. Dis Colon Rectum, 2011, 54(2):151-156.
5. Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome[J]. Colorectal Dis, 2012, 14(4):e134-e156.
6. Rosenberg J, Fischer A, Haglind E, et al. Current controversies in colorectal surgery:the way to resolve uncertainty and move forward[J]. Colorectal Dis, 2012, 14(3):266-269.
7. Kwon DS, Chang GJ. The role of minimally invasive surgery and outcomes in colorectal cancer[J]. Perm J, 2011, 15(3):61-66.
8. Kang J, Min BS, Hur H, et al. Transanal specimen extraction in robotic rectal cancer surgery[J]. Br J Surg, 2012, 99(1):133-136.
9. Kang J, Min BS, Park YA, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery[J]. World J Surg, 2011, 35(11):2555-2562.
10. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J]. Dis Colon Rectum, 2002, 45(12):1689-1694.
11. Delaney CP, Lynch AC, Senagore AJ, et al. Comparison ofrobotically performed and traditional laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2003, 46(12):1633-1639.
12. Hellan M, Anderson C, Ellenhorn JD, et al. Short-term outcomesafter robotic-assisted total mesorectal excision for rectal cancer[J].Ann Surg Oncol, 2007, 14(11):3168-3173.
13. 丁超, 江志偉, 黎介壽. 達(dá)芬奇手術(shù)機(jī)器人在結(jié)直腸手術(shù)中的應(yīng)用[J]. 腹腔鏡外科雜志, 2011, 16(7):556-558.
14. Baik SH, Lee WJ, Rha KH, et al. Robotic total mesorectal excision for rectal cancer using four robotic arms[J]. Surg Endosc, 2008, 22(3):792-797.
15. Kang J, Hur H, Min BS, et al. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer:starting with the perianal approach followed by robotic procedure[J]. Ann Surg Oncol, 2012, 19(1):154-155.
16. Patriti A, Ceccarelli G, Bartoli A, et al. Short-and medium-termoutcome of robot-assisted and traditional laparoscopic rectalresection[J]. JSLS, 2009, 13(2):176-183.
17. Shin JY. Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during earlyexperience[J]. J Korean Soc Coloproctol, 2012, 28(1):19-26.
18. Park YA, Kim JM, Kim SA, et al. Totally robotic surgery for rectal cancer:from splenic flexure to pelvic floor in one setup[J]. Surg Endosc, 2010, 24(3):715-720.
19. Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resectionwith total mesorectal excision and splenic flexure mobilization[J]. Surg Endosc, 2009, 23(2):447-451.
20. 曾冬竹, 余佩武, 雷曉, 等. 達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在直腸癌根治術(shù)中的應(yīng)用[J]. 中華消化外科雜志, 2011, 10(6):436-438.
21. deSouza AL, Prasad LM, Marecik SJ, et al. Total mesorectal excision for rectal cancer:the potential advantage of roboticassistance[J]. Dis Colon Rectum, 2010, 53(12):1611-1617.
22. Biffi R, Luca F, Pozzi S, et al. Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer[J]. J Robot Surg, 2011, 5(2):101-107.
23. Hottenrott C. Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis[J]. Surg Endosc, 2011, 25(12):3954-3956.
24. 張雪峰, 李瑾, 郭一君, 等. 達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)輔助直腸前切除一例[J]. 中華臨床醫(yī)師雜志:電子版, 2011, 5(19):5843-5844.
25. Prasad SM, Maniar HS, Soper NJ, et al. The effect of robotic assistance on learning curves for basic laparoscopic skills[J]. Am J Surg, 2002, 183(6):702-707.
  1. 1. Thiel DD, Winfield HN. Robotics in urology:past, present, and future[J]. J Endourol, 2008, 22(4):825-830.
  2. 2. 朱軍, 丁健華, 湯海燕, 等. 腹腔鏡與開腹全直腸系膜切除術(shù)治療中低位直腸癌的臨床對照研究[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(6):636-641.
  3. 3. Leong QM, Kim SH. Robot-assisted rectal surgery for malignancy:a review of current literature[J]. Ann Acad Med Singapore, 2011, 40(10):460-466.
  4. 4. Kwak JM, Kim SH, Kim J, et al. Robotic vs. laparoscopic resection of rectal cancer:short-term outcomes of a case-control study[J]. Dis Colon Rectum, 2011, 54(2):151-156.
  5. 5. Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome[J]. Colorectal Dis, 2012, 14(4):e134-e156.
  6. 6. Rosenberg J, Fischer A, Haglind E, et al. Current controversies in colorectal surgery:the way to resolve uncertainty and move forward[J]. Colorectal Dis, 2012, 14(3):266-269.
  7. 7. Kwon DS, Chang GJ. The role of minimally invasive surgery and outcomes in colorectal cancer[J]. Perm J, 2011, 15(3):61-66.
  8. 8. Kang J, Min BS, Hur H, et al. Transanal specimen extraction in robotic rectal cancer surgery[J]. Br J Surg, 2012, 99(1):133-136.
  9. 9. Kang J, Min BS, Park YA, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery[J]. World J Surg, 2011, 35(11):2555-2562.
  10. 10. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J]. Dis Colon Rectum, 2002, 45(12):1689-1694.
  11. 11. Delaney CP, Lynch AC, Senagore AJ, et al. Comparison ofrobotically performed and traditional laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2003, 46(12):1633-1639.
  12. 12. Hellan M, Anderson C, Ellenhorn JD, et al. Short-term outcomesafter robotic-assisted total mesorectal excision for rectal cancer[J].Ann Surg Oncol, 2007, 14(11):3168-3173.
  13. 13. 丁超, 江志偉, 黎介壽. 達(dá)芬奇手術(shù)機(jī)器人在結(jié)直腸手術(shù)中的應(yīng)用[J]. 腹腔鏡外科雜志, 2011, 16(7):556-558.
  14. 14. Baik SH, Lee WJ, Rha KH, et al. Robotic total mesorectal excision for rectal cancer using four robotic arms[J]. Surg Endosc, 2008, 22(3):792-797.
  15. 15. Kang J, Hur H, Min BS, et al. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer:starting with the perianal approach followed by robotic procedure[J]. Ann Surg Oncol, 2012, 19(1):154-155.
  16. 16. Patriti A, Ceccarelli G, Bartoli A, et al. Short-and medium-termoutcome of robot-assisted and traditional laparoscopic rectalresection[J]. JSLS, 2009, 13(2):176-183.
  17. 17. Shin JY. Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during earlyexperience[J]. J Korean Soc Coloproctol, 2012, 28(1):19-26.
  18. 18. Park YA, Kim JM, Kim SA, et al. Totally robotic surgery for rectal cancer:from splenic flexure to pelvic floor in one setup[J]. Surg Endosc, 2010, 24(3):715-720.
  19. 19. Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resectionwith total mesorectal excision and splenic flexure mobilization[J]. Surg Endosc, 2009, 23(2):447-451.
  20. 20. 曾冬竹, 余佩武, 雷曉, 等. 達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)在直腸癌根治術(shù)中的應(yīng)用[J]. 中華消化外科雜志, 2011, 10(6):436-438.
  21. 21. deSouza AL, Prasad LM, Marecik SJ, et al. Total mesorectal excision for rectal cancer:the potential advantage of roboticassistance[J]. Dis Colon Rectum, 2010, 53(12):1611-1617.
  22. 22. Biffi R, Luca F, Pozzi S, et al. Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer[J]. J Robot Surg, 2011, 5(2):101-107.
  23. 23. Hottenrott C. Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis[J]. Surg Endosc, 2011, 25(12):3954-3956.
  24. 24. 張雪峰, 李瑾, 郭一君, 等. 達(dá)芬奇機(jī)器人手術(shù)系統(tǒng)輔助直腸前切除一例[J]. 中華臨床醫(yī)師雜志:電子版, 2011, 5(19):5843-5844.
  25. 25. Prasad SM, Maniar HS, Soper NJ, et al. The effect of robotic assistance on learning curves for basic laparoscopic skills[J]. Am J Surg, 2002, 183(6):702-707.