CAJ | 학술논문

目的探讨机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤的临床应用价值。方法回顾性分析2010年5月至2014年4月上海瑞金医院应用达芬奇机器人辅助胰头十二指肠切除术治疗的38例胰头部恶性肿瘤患者临床资料。其中男25例，女13例；平均年龄（59±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。采用“五孔法”置入3枚机器人专用套管（Trocar）及1枚镜头Trocar和1枚辅助Trocar，放入机器人臂，机器人辅助下行胰头十二指肠切除术。观察患者围手术期情况，包括手术时间、术中出血量、手术情况、术后并发症和生存情况等。结果38例均顺利完成，完全切除（ R0）切除率97%（37/38），R1切除率3%（1/38），中位手术时间413（210～520）min，术中出血量320（50～1100）ml，淋巴结清扫数15(2～24)个。术后住院时间20(7～36) d，术后并发症发生率42%（16/38），其中胰瘘8例、胆瘘2例、术后感染6例。术后生存时间25（3～42）个月，无瘤生存时间14（5～28）个月。结论采取机器人辅助胰头十二指肠切除术切除胰头部恶性肿瘤安全、可行。
목적탐토궤기인보조이두십이지장절제술치료이두부악성종류적림상응용개치。방법회고성분석2010년5월지2014년4월상해서금의원응용체분기궤기인보조이두십이지장절제술치료적38례이두부악성종류환자림상자료。기중남25례，녀13례；평균년령（59±10）세。소유환자균첨서지정동의서，부합의학윤리학규정。채용“오공법”치입3매궤기인전용투관（Trocar）급1매경두Trocar화1매보조Trocar，방입궤기인비，궤기인보조하행이두십이지장절제술。관찰환자위수술기정황，포괄수술시간、술중출혈량、수술정황、술후병발증화생존정황등。결과38례균순리완성，완전절제（ R0）절제솔97%（37/38），R1절제솔3%（1/38），중위수술시간413（210～520）min，술중출혈량320（50～1100）ml，림파결청소수15(2～24)개。술후주원시간20(7～36) d，술후병발증발생솔42%（16/38），기중이루8례、담루2례、술후감염6례。술후생존시간25（3～42）개월，무류생존시간14（5～28）개월。결론채취궤기인보조이두십이지장절제술절제이두부악성종류안전、가행。
ObjectiveTo investigate the clinical application value of pancreaticoduodenectomy with the assistance of robotic operation system for pancreatic head cancer.MethodsClinical data of 38 patients with pancreatic head cancer undergoing pancreaticoduodenectomy using Da Vinci Si robotic system in Shanghai Ruijin Hospital from May 2010 to April 2014 were analyzed retrospectively. There were 25 males and 13 females with the mean age of (59±10) years old. The informed consents of all patients were obtained and the ethical committee approval was received. Three robotic exclusive Trocars, 1 camera Trocar and 1 assistant Trocar were inserted using 5-port approach and the robotic arms were inserted. Pancreaticoduodenectomy was performed under the assistance of robotic system. The perioperative situation including operation time, intraoperative blood loss, operation, postoperative complication and survive were observed.ResultsAll the operations of 38 cases were finished successfully with radical (R0) resection rate 97% (37/38), R1 resection rate 3% (1/38) and the median operation time 413(210-520)min, intraoperative blood loss 320(50-1 100)ml, lymphnode clearance number 15(2-24), postoperative hospital stay 20(7-36)d. The incidence of postoperative complication was 42% (16/38) including pancreatic ifstula (n=8), biliary ifstula (n=2), postoperative infection (n=6). The postoperative survival time was 25(3-42) months and disease-free survival time was 14(5-28) months.ConclusionPancreaticoduodenectomy with the assistance of robotic operation system is safe and feasible for resecting pancreatic head cancer.