达芬奇机器人辅助下复杂肝内胆管结石的外科治疗

目的探讨达芬奇机器人手术治疗复杂肝内胆管结石的疗效和预后情况。方法对笔者所在单位2009年1月至2011年8月期间15例接受机器人辅助下手术治疗的复杂肝内胆管结石患者的临床资料进行回顾性分析。结果 15例患者均顺利完成手术,无中转开腹,术中无损伤重要血管及脏器发生,术后并发症4例(26.7%),其中胆道出血1例(6.7%),肝创面出血2例(13.3%),肺部感染1例(6.7%),无围手术期肝功能衰竭及死亡病例。15例均获随访,随访时间3个月～2年,平均11个月,总体随访率100%,疗效优良者12例(80.0%),残余结石者3例(20.0%),结石复发者1例(6.7%)。结论达芬奇机器人辅助下治疗高龄、多次手术史、肝功能差及伴急性胆管炎等复杂肝内胆管结石患者具有巨大的潜力。

Da Vinci Roboti-Assisted Surgical Treatment of Complex Hepatolithiasis

Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis.Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively.Results All operations of 15 patients were performed successfully,no case of converting to laparotomy,no injury of the important blood vessels and organs in surgical procedures.Postoperative complications occurred in 4 cases(26.7%).Among them,there were 1 case(6.7%) of hemobilia,1 case(6.7%) of lung infection,2 cases(13.3%) of liver surface bleeding,and no case of death and liver failure occurred during the perioperative period.All patients(100%) had follow-up visited with a median time of 11 months(ranging from 3 months to 2 years),12 cases(80.0%) acquired good curative effect,3 cases(20.0%) of residual stones were found,1 case(6.7%) of recurrence stones were found.Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis,which can be used in elderly patients,and patients with multiple surgical history,poor liver function,acute cholangitis,and so on.