达芬奇手术机器人在全结肠切除手术中的应用研究

目的探讨应用达芬奇手术机器人Si系统行全结肠切除术的可行性。 方法回顾性分析2017年12月至2019年8月中国人民解放军联勤保障部队第940医院结直肠肛门外科用达芬奇手术机器人Si系统进行全结肠直肠切除手术7例的临床资料。手术采用腹部5个戳卡、2次变换手术体位、2次对接机器人的方法进行。 结果7例患者中4例为家族性结肠息肉病，其中2例有恶性变；2例为慢传输型便秘，其中1例合并有直肠癌；1例为结直肠多原发癌。中转开腹2例，1例因较严重的上腹部粘连中转，另1例因合并巨结肠而中转开腹；无手术并发症发生，无围手术期死亡。平均手术时间为（332.0±95.2）min（150~430 min），未中转开腹的平均手术时间为（364.0±61.9）min（280~430 min）；机器人平均安装时间为（37.9±6.4）min（30~50 min），中间转换机器人位置的平均时间为（14.0±2.2）min（10~15 min）。平均估计失血量为（157.1±60.8）mL（100~250 mL）。对于恶性病例，淋巴结检出数目平均（26.3±15.2）枚（18~49枚）。 结论采用腹壁5孔、2次变换手术体位、2次对接机器人的方法进行全结肠直肠切除手术安全可行，亦可达到根治的效果。

Clinical research of Da Vinci surgical robot in total colectomy

Objective To investigate the feasibility of total colectomy with Da Vinci robot Si system.Methods From December 2017 to August 2019,the clinical data of 7 cases with total colorectal resection performed by Da Vinci surgical robot SI system in the department of colorectal surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army.The clinical data were analyzed retrospectively.The operation was carried out by five punch cards in the abdomen,two changes of operation position and two docking robots.Results Of the seven patients,four were familial polyposis of colon,two of them had malignant change;two were slow transit constipation,one of them had colorectal cancer and one had multiple primary colorectal cancer.Two patients were converted to open surgery,one was converted to open surgery because of severe upper abdominal adhesion,the other was converted to open surgery because of megacolon.There were no complications occurred during the operation and no perioperative death.The average operation time was(332.0±95.2)min(150~430 min),the average time of the uninterrupted laparotomy was(364.0±61.9)min(280~430 min);the robot installation time was(37.9±6.4)min(30~50 min),and the intermediate conversion robot position was(14.0±2.2)min(10~15 min).The average estimated blood loss was(157.1±60.8)mL(100~250 mL).For malignant cases,the number of extracted lymph nodes were 18~49,with an average of(26.3±15.2).Conclusions The method of performing a total colorectal resection with five holes in the abdominal wall,two times of changing the surgical position,and two times of docking robot is safe and feasible,and can also achieve the effect of radical treatment.