手术机器人系统在120例胃癌患者治疗中的应用

目的总结应用达芬奇手术机器人系统治疗胃癌的经验,并探讨其安全性及有效性。方法2010年5月至2012年4月间．应用达芬奇手术机器人系统治疗胃癌患者共计120例。综合分析这组患者的手术及近期康复结果。结果120例患者中男74例,女46例;平均年龄58．5（22-80）岁。其中远端胃次全切除62例,全胃切除35例。近端胃次全切除23例：其中55例患者采用了腹部辅助小切口完成消化道重建：65例在机器人系统下完成消化道重建。中转开腹1例（0．9％）。手术时间（245±50）min,其中装机时间（17±5）min。术中出血量（70±45）ml,获取淋巴结数为（22．5±10．7）枚／例;切除标本切缘均阴性。术后病理分期：ⅠB期24例,Ⅱ期28例,ⅢA期47例,ⅢB期21例。术后并发症发生率为5％（6／120）,分别为十二指肠残端瘘1例。食管残胃吻合口瘘2例,术后肠梗阻1例,残胃排空障碍1例和术后出血1例：通过手术或保守治疗均获得治愈。无围手术期死亡者。术后住院时间（6．3±2．6）d。结论达芬奇手术机器人系统应用于胃癌手术创伤小、出血少并安全有效。在淋巴结清扫及消化道吻合重建方面更具有独特的优越性。

Application of surgical robotic system in patients with gastric cancer: a report of 120 cases

Objective To evaluate the safety, feasibility, and efficacy of robotic gastrectomy for gastric cancer using da Vinci surgical system. Methods A total of 120 patients who underwent robotic gastrectomy using da Vinci surgical system for gastric cancer from May 2010 to April 2012. Data regarding surgical and early oncological outcomes were systematically collected in a specific database for statistical analysis. Results There were 74 males and 46 females, with a mean age of 58.5（22-80） years old. The type of robotic operation included 62 distal subtotal gastrectomies, 35 total- gastrectomies, and 23 proximal gastrectomies. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in 55 cases, and intracorporeal robot-sewn anastomosis in 65 cases. There was 1 conversion （0.9%）. The operative time was（245±50） min and the docking time （17±5） min. The blood loss was（70±45） ml. The number of harvested lymph nodes was 22.5±10.7. The resection margins were negative in all surgical specimens. The postoperative pathological stage consisted of stage Ⅰ B in 24 cases, stage Ⅱ in 28, stage ⅢA in 47, and stage ⅢB in 21. Six patients（5%） developed postoperative complication including 1 case of duodenal stump leakage, 2 cases of esophagus- gastric leakage, 1 case of small bowel obstruction, 1 case of delayed gastric empting, and 1 case of abdominal bleeding. All the complications were cured by reoperation or conservative therapy, and there were no postoperative 30-day deaths. The postoperative hospital stay was （6.3_＋2.6） days. Conclusion Robotic gastrectomy for the treatment of gastric cancer is a feasible and safe procedure, and isadvantageous in terms of lymphadenectomy and alimentary tract reconstruction.