CAJ | 학술논문

机器人外科是一项新兴技术，拓宽了腹腔镜技术在外科领域的应用。达芬奇机器人手术系统自2000年获得FDA批准后，国外多家医疗机构陆续开展临床应用，其安全性与疗效已得到肯定与共识。沈阳军区总医院自2011年引进该设备，普外科目前共完成达芬奇机器人手术180例，其中腹腔多器官联合切除4例，占2.2％。4例中直肠前切除＋右半结肠切除1例，直肠前切除＋脾脏切除1例，直肠前切除＋阑尾切除1例，直肠前切除＋子宫全切1例。传统腹腔镜联合脏器切除手术大多是以良性病症为主，因为腹腔镜肿瘤手术要求不仅切除病灶，还要清扫其所属淋巴组织，手术难度势必较良性病变要高很多，加上传统腔镜器械在操作中存在“筷子效应”，限制了以肿瘤根治为主的传统腹腔镜多脏器联合切除的临床应用。达芬奇手术机器人因为具备了可达到7个自由度的手术器械的优势，使手术操作具有极大的灵巧性，化解了上述技术难题，在涉及肠道恶性肿瘤的联合脏器切除手术中具备很大优势。本组4例病患手术均顺利完成，术后恢复良好，未见严重并发症。笔者认为在适应证选择方面仍需谨慎，注意多学科合作并做好术前计划。
궤기인외과시일항신흥기술，탁관료복강경기술재외과영역적응용。체분기궤기인수술계통자2000년획득FDA비준후，국외다가의료궤구륙속개전림상응용，기안전성여료효이득도긍정여공식。침양군구총의원자2011년인진해설비，보외과목전공완성체분기궤기인수술180례，기중복강다기관연합절제4례，점2.2％。4례중직장전절제＋우반결장절제1례，직장전절제＋비장절제1례，직장전절제＋란미절제1례，직장전절제＋자궁전절1례。전통복강경연합장기절제수술대다시이량성병증위주，인위복강경종류수술요구불부절제병조，환요청소기소속림파조직，수술난도세필교량성병변요고흔다，가상전통강경기계재조작중존재“쾌자효응”，한제료이종류근치위주적전통복강경다장기연합절제적림상응용。체분기수술궤기인인위구비료가체도7개자유도적수술기계적우세，사수술조작구유겁대적령교성，화해료상술기술난제，재섭급장도악성종류적연합장기절제수술중구비흔대우세。본조4례병환수술균순리완성，술후회복량호，미견엄중병발증。필자인위재괄응증선택방면잉수근신，주의다학과합작병주호술전계화。
The daVinci Surgery System is an emerging technology,which has broaden the application of laparoscopy in surgical field.Since FDA approved the daVinci Surgical System in 2000,a number of medical institutions have used it in clinics worldwide and its clinical efficacy and safety have also been approved.Our department has completed 180 robot-assisted operations since the system was introduced into our hospital in 2011.Of these operations,4 were combined resection of organs(2.2%) in which one case was the rectal anterior resection and right hemicolectomy,one was the rectal anterior resection plus splenectomy,one was the rectal anterior re-section and appendectomy and one was the rectal anterior resection and hysterectomy.The most operations of combined resection of or-gans by using traditional laparoscopy were benign tumors.This is because that the radical resection of malignant tumor was relatively dif-ficult and the traditional laparoscopy has limitation to complete such operations.In contrast,the daVinci Surgical System has advantages of 7 degree-of-freedom operation instrument that makes the operation has a great dexterity.Therefore,the system has a great advantage in the operations of combined resection of organs.The operations in the 4 cases were successfully completed.Postoperative recovery was well and no serious complications were found.The authors suggested that the selection of the operation indications still need to be cau-tious and multidisciplinary cooperation and preoperative plan should be noticed.