CAJ | 학술논문

目的探讨达芬奇机器人手术系统在胆道恶性疾病微创手术中应用的可行性、安全性及优势.方法回顾性分析了2009年3月至2013年3月解放军总医院应用达芬奇机器人手术系统对19例胆道恶性疾病微创手术患者的临床资料.结果除1例中转开腹外,所有患者均通过该系统成功完成手术.其中实施大范围肝切除11例,肝十二指肠韧带淋巴结清扫17例,胆肠吻合14例.手术时间为(504±194) min (210～720 min).术中失血量20～3000ml,输血5例.1例因术后肝衰竭于术后18 d死亡.术后并发症5例(26.3％),其中3例为一过性胆漏,自愈；1例为术后门静脉狭窄,行二次开腹手术门静脉切除重建后治愈；1例为肝固有动脉假性动脉瘤破裂出血,行二次开腹手术动脉瘤切除、动脉端端吻合后治愈.术后平均住院时间14.7d.结论达芬奇机器人手术系统能够安全有效地完成各类胆道恶性疾病的微创外科手术,尤其对复杂的胆道重建手术优势更明显,但对于联合大范围肝切除的肝门部胆管癌根治术,其技术系统还需进一步优化.
목적 탐토체분기궤기인수술계통재담도악성질병미창수술중응용적가행성、안전성급우세.방법 회고성분석료2009년3월지2013년3월해방군총의원응용체분기궤기인수술계통대19례담도악성질병미창수술환자적림상자료.결과 제1례중전개복외,소유환자균통과해계통성공완성수술.기중실시대범위간절제11례,간십이지장인대림파결청소17례,담장문합14례.수술시간위(504±194) min (210～720 min).술중실혈량20～3000ml,수혈5례.1례인술후간쇠갈우술후18 d사망.술후병발증5례(26.3％),기중3례위일과성담루,자유；1례위술후문정맥협착,행이차개복수술문정맥절제중건후치유；1례위간고유동맥가성동맥류파렬출혈,행이차개복수술동맥류절제、동맥단단문합후치유.술후평균주원시간14.7d.결론 체분기궤기인수술계통능구안전유효지완성각류담도악성질병적미창외과수술,우기대복잡적담도중건수술우세경명현,단대우연합대범위간절제적간문부담관암근치술,기기술계통환수진일보우화.
Objective To evaluate the application of the Da Vinci surgical system for malignant biliary disease.Methods Between March 2009 and March 2013,19 patients with malignant biliary diseases underwent robotic biliary surgeries at the PLA General Hospital and were analyzed retrospectively.Results The robotic surgeries were performed successfully on 18 patients and 1 was converted to open surgery.Among the 19 surgeries,11 patients underwent major hepatectomies,17 patients underwent a radical lymphodenectomy and 14 patients underwent an Roux-en-Y hepaticojejunostomy.The mean operative time was (504± 194) minutes.Intraoperative blood loss ranged from 20 to 3000 ml and blood transfusions were required in 5 patients.1 patient died of liver failure at day 18 postoperation.The postoperative morbidity rate was 26.3％ (5 cases).These complications included 3 transient bile leakages,1 portal vein stenosis and 1 hepatic artery pseudoaneurysm.Both patients with the portal vein and hepatic artery complications received the stenosis and pseudoaneurysm resection with vascular reconstruction.The mean postoperative hospital stay was 14.7 days.Conclusions The minimally invasive surgery for malignant biliary diseases was safe and feasible when assisted by the Da Vinci surgical system,and there was a potential ascendancy in the procedures which required an endoscopic re construction of the biliary tract.However,the procedures and surgical techniques should be refined for hilar cholangiocarcinoma due to its higher complication rate.