达芬奇机器人手术系统应用于直肠癌根治术101例的近期疗效观察

目的探讨达芬奇机器人手术系统应用于直肠癌根治术的可行性及安全性，总结其临床应用经验及近期疗效。方法回顾性分析第三军医大学西南医院2010年3月至2012年9月行达芬奇机器人手术系统直肠癌根治术101例患者的临床资料。对其手术情况、并发症发生情况和术后恢复情况及病理性资料进行分析评估。结果101例患者均顺利完成达芬奇机器人手术系统直肠癌根治术，无中转开腹者。采用低位前切除术式（Dixon）73例，经腹会阴联合切除术式（Miles）28例。手术时间（210．3±47．2）min，术中出血量（60．5±28．7）ml。淋巴结清扫（17．3±5．4）枚。术后患者排气时间（2．7±0．7）d。病理提示远切缘距肿瘤（5．3±2．3）cm，无癌细胞残留。术后并发症发生率为6．9％（7／101），其中吻合口瘘2例，会阴部切口感染2例，肺部感染2例，尿潴留1例。无死亡病例。全组患者随访时间（12．9±8．0）月，有2例（2．0％）发生远处转移，无局部复发。结论达芬奇机器人手术系统应用于直肠癌根治术安全、创伤小、恢复快，近期疗效满意。

Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients

Objective To investigate the feasibility and safety of da Vinci robotic surgical system in metal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Methods Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. Results All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was （210.3±47.2） min. The average blood lose was （60.5±28.7） ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was （2.7＋0.7） d. Distal margin was （5.3±2.3） cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage （n=2）, perineum incision infection （n=2）, pulmonary infection （n=2）, urinary retention （n=1）. There was no postoperative death. The mean follow-up time was （12.9±8.0） months. No local recurrence was found except 2 cases with distant metastasis. Conclusion Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.