机器人直肠癌根治术临床应用探讨

目的 探讨达芬奇机器人手术系统在直肠癌根治术中的应用经验,总结手术操作技巧.方法 回顾性分析我院2009年6月至2011年11月行达芬奇机器人直肠癌根治术25例临床资料.结果 25例患者均顺利行机器人直肠癌根治术,无中转开腹病例.其中Dixon术式19例,Miles术式6例.手术时间平均235.5 min,术中平均出血量60.8 ml,2例因术前贫血给予输血,其余23例均未输血.淋巴结清扫10～23枚,平均13.1枚.术后排气时间33 ～ 116 h,平均73.5 h.病理切缘均为阴性.术后1例Miles患者发生会阴部切口裂开,1例Dixon患者发生肺部感染,无手术死亡病例.随访时间21～51个月,平均30.9个月,1例发生吻合口复发,2例发生肝转移.结论 达芬奇机器人直肠癌根治术操作简单、创伤小、恢复快,其独特的3D视野能清晰显露并保护输尿管、髂腹下神经和盆腔自主神经丛等重要脏器.

Treatment of rectal cancer with da Vinci robotic surgical system

Objective To explore the experience of radical resection of rectal cancer with the da Vinci robotic surgical system, especially on the operational skills. Methods Clinical data of 25 cases of rectal cancer which received robotic radical resection were reviewed. Results All patients were received radical resection successfully under general anesthesia with robotic surgical system of da Vinci. There were nineteen cases of Dixon and 6 cases of Miles operation were done. The average operational time was 235.5min. The mean blood loss during operation was 60.8 mh and 2 cases received blood transfusion because of anemia. The average number of lymph node dissected was 13.1, ranged 10 to 23. The average time for gastrointestinal function recovery was 73.5 h, ranged 33 h to 116 h. 1 case of incision disruption and 1 case of pulmonary infections was found in Miles and Dixon respectively, the two cases were cured by conservative therapy. There were no postoperative death in this series. All the cases were followed up for 21 to 51 months （mean 30.9 months） and revealed one case of anastomosis recurrence and two cases of liver metastasis. Conclusion The radical resection of rectal carcinoma with da Vinci robotic system isfeasible, safe, quicker recovery, and minimally invasive. Under the 3D view, the ureter, inferior hypogastric plexus and pelvic plexus were clearly exposed and preserved.