机器人辅助胰腺手术的消化道重建:胰肠吻合还是胰胃吻合

目的 总结分析机器人辅助胰腺切除术中胰肠吻合术与胰胃吻合术的临床特点与手术技巧,分析比较两种吻合方式的优劣.方法 回顾性分析2010年3月至2012年2月上海瑞金医院应用达芬奇机器人辅助手术系统行24例胰腺吻合术的临床资料.结果 24例胰腺吻合术均在达芬奇机器人辅助手术系统下完成,无中转开腹.其中男10例,女14例,平均年龄( 48.58±13.31)岁,术中切除肿瘤平均大小( 2.74±1.31)cm,胰管平均直径(3.58±1.69 )mm,胰腺吻合口平均完成时间( 57.71±13.10) min,其中行胰肠吻合术12例,胰胃吻合术12例,术后并发胰漏者9例(37.5％)、胰腺吻合口出血者2例(8.3％)、胃排空延迟者1例(4.2％),均经过保守治疗后康复.术后平均住院时间为( 23.88±8.02)d,胰腺吻合口旁引流管留置时间为(18.83±7.23)d,肛门排气恢复时间为( 2.38±1.24)d.进一步研究发现,与胰肠吻合术组比较,胰胃吻合术组吻合时间长、术后胰漏发生率较高(P＜0.05),但两组术后住院时间、吻合口引流时间、肛门排气时间差异无统计学意义.结论 在机器人辅助手术系统下完成胰胃吻合或胰肠吻合均是安全可行的,具体吻合方式的选择应综合考虑手术方式与外科医师的手术经验.

Reconstruction of digestive tract in robotic pancreatic surgery: pancreaticojejunostomy or pancreaticogastrostomy

Objective To investigate and compare the clinical features and surgical techniques of pancreaticojejunostomy and pancreaticogastrostomy in robotic pancreatic surgery. Methods From March 2010 to February 2012, 24 patients received da Vinci robotic-assisted pancreatic surgery in Shanghai Ruijin Hospital were analyzed retrospectively. Results Operations were successfully performed in 24 cases without conversion to open surgery. There were 10 males and 14 females, with a mean age of 48.58±13.31 years old. The average tumor size was 2.74±1.31 cm, and the average diameter of pancreatic duct was 3.58±1.66cm. The average operation time of pancreatic anastomosis was 57.71±13.10 min, which included 12 cases of pancreaticojejunostomy and 12 case of pancreaticogastrostomy. The postoperative complications included pancreatic fistula in 9 cases( 37.5 % ), pancreatic anastomotic bleeding in 2 cases( 8.3 % ),delayed gastric emptying in 1 case( 4.2 % ).All of them were recovered after conservative treatment.The mean postoperative hospital stay was 23.88±8.02 days. The drainage period of pancreatic anastomosis was 18.83± 7.23 days, and flatus recovery time was 2.38± 1.24 days. Compared with pancreaticojejunostomy group, the pancreaticogastrostomy group needed more time to complete the pancreatic anastomosis and presented a higher rate of pancreatic fistula(P<0.05). But there was no significant difference in postoperative hospital stay, anastomotic drainage time, anal flatus recovery time. Conclusions Both pancreaticogastrostomy and pancreaticojejunostomy are safe and feasible. The method of pancreatic anastomosis in robotic pancreatic surgery should be selected by the whole surgical procedure and surgeon experience.