达芬奇机器人胃癌根治术41例

目的探讨达芬奇机器人胃癌根治术的安全性及可行性。方法回顾性分析2010年3月至2011年12月间第三军医大学西南医院普通外科中心收治并实施达芬奇机器人胃癌根治术的41例患者的临床资料．其中根治性全胃切除术12例．远端胃大部切除术29例。结果41例患者中1例中转开腹手术．1例中转传统腹腔镜手术;其余患者均顺利完成达芬奇机器人胃癌D：根治术。39例患者中28例远端胃大部分切除术手术时间（225±39）min,术中出血量（150±127）ml;11例全胃切除术手术时间（285±61）min,术中出血量（180±157）ml;全组清扫淋巴结（34．2±18．5）枚。术后胃肠功能恢复时间（3．1±1．2）d,下床活动时间（2．7±1．5）d,进流食时间（3．7±1．5）d;2例出现并发症,其中1例切口感染,另1例肺部感染。术后随访1～21（中位随访11）个月,4例患者因腹腔种植转移死亡．1例带瘤存活．其余36例患者均无瘤存活。结论达芬奇机器人胃癌根治手术安全可行,具有手术视野放大清晰、解剖分离精细灵巧、创伤小、恢复快等优点。

Robotic-assisted radical gastrectomy using da Vinci robotic system: a report of 41 cases

Objective To investigate the feasibility and safety of da Vinci robotic-assisted radical gastrectomy for gastric cancer. Methods Forty-one patients with gastric cancer from Southwest Hospital between March 2010 and December 2011 underwent da Vinci robotic-assisted radical gastrectomy including total gastrectomy （n=12） and distal gastrectomy （n=29）. Results Conversion was required in two patients. One was converted to open surgery, and the other to conventional laparoscopic surgery. The remaining thirty-nine patients underwent da Vinci robotic-assisted radical gastrectomy successfully. The mean operative time was （285±61） min for total gastrectomy, and （225± 39） min for distal gastrectomy. The mean blood loss was- （180±157） ml in total gastrectomy, and （150±127） ml in distal gastrectomy. The mean number of harvested lymph nodes was 34.2±18.5. The mean time for gastrointestinal function recovery was （3.1 ±1.2） days. The time to ambulation was （2.7± 1.5） days. The time to oral liquid intake was （3.7±1.5） days. Two patients had complication including wound infection and pneumonia. After follow up ranging from 1 to 21 months （median 11 months）, 4 patients died from peritoneal metastasis, 1 survived with tumor, and the remaining 36 patients survived without disease. Conclusions da Vinci robotic-assisted radical gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma and fast recovery.